DailyKaizen

Continuous incremental improvement of an activity to eliminate waste

I actually don’t have this definition in my head. I have to refresh my memory once in a while to match it to the greatness that a Kaizen is.

I just participated in one this week on the process of durable medical equipment procurement for our patients. The end product was exactly what a kaizen should produce: incremental improvement. It did not shift techtonic plates, it did not solve every issue, but it cleared a path, and left me, on Thursday, seeing the next step. The step I have in my hand now is a way to use our electronic systems to support physicians in ordering the right equipment the right way each time, saving our patients’ time and money.

That’s Kaizen!

This morning I am reporting live from Day Four of a Kaizen focused on improving cycle times, quality and efficency in our Information Service Division (ISD).  The Kaizen is being led by a group of ISD staff that have gone through some LEAN training with this being their first Workshop.  I have been attending the Kaizen to support them when it has been needed.  I woke up early this morning excited and nervous about what the day will hold.  Yesterday I had to leave the Kaizen early to attend an event which meant that I needed to let go and trust that the new facilitators would do a good job. 

I am sitting now in the conference room where the event is being held and am amazed by how much work got done while I was gone.  Our Visual System that monitors the Workshop’s progress shows that we have already completed more then 50% of the projects for the week.  I can’t wait to see the day when throughout the organization teams like this one are leading their own improvement events for the benefit of our patients.  Kudos go out to the ISD Team! 

Yesterday we celebrated the functional end of our value stream mapping and process improvement work for health information technology. It was good to reflect on where we are. Just yesterday I received several message exchanges that started with, “We would like you to do this work, can you do it?” and ended with, “Yes we can, and we will do it during this event.”

That’s a “wow” for me. Last year, an exchange like that would have generated panic and a rush to indicate why new work could not be commissioned. Now, it’s just a pat on the back and a smile. That’s LEAN!

I am working with a group of new RPI faciliators this week to help them lead their first Kaizen.  They are doing a great job.  We are tackling a very broken process with a very large scope.  It is great to see the light going off in their eyes and those that they are learning how to lead.  The team is all frontline staff and the faciliators are their peers.  I think this week will be a great case study of how LEAN Thinking transends organizational structures and will prove that leadership can be found and fostered at all levels.  Stay tuned…

I am currently reading about employee engagement - now at historic lows in US businesses (71 % disengaged) and the toll it takes on organizational productivity. In a business like healthcare there is little room to waste employee engagement.
For the last several days, I have been engaged remotely with one of our rapid process improvement teams around the build of a specific tool to measure depression in our clinical information system. The solution from the IT perspective is not straightforward, with lots and twists and turns.
Several people have asked me, “why wasn’t this worked out BEFORE you engaged clinical staff - they just wanted the finished product?” I would ask a different question, a deeper one: “How engaged do we want those who serve our patients to be in solving problems on behalf of the organization?” My answer : very. If we cannot have engagement in the “how” as well as the “what” we do to solve problems, we will continue to keep knowledge within a walled garden and risk disengagement.
With the horrendous state of employee engagement in business today, we can use LEAN to create competitive advantage for our members.
We have not yet gotten the evaluations from this particular RPI, which is a caveat to all of this……

Here is one of my favorites from one of my favorites:

“It is common sense to take a method and try it; if it fails, admit it frankly and try another. But above all, try something.“

–Franklin D. Roosevelt  

I had a really interesting talk yesterday with my neighbor.  It was the first time we had met and so we naturally drifted our small talk onto the subject of what we do for work.  As it turns out, he is a Boeing line manager that has had over eight years of exposure to LEAN, which he views very positively. 

He was excited when I mentioned that I am a LEAN consultant that is working in healthcare.  His first comment was “man you guys really need it.”  He then launched into a long story about all of the difficulties he has had in managing the decline in health of both his parents.  He told me several horror stories both on the delivery system and insurance sides (none-within Group Health) about his attempt to coordinate his parent’s care and getting information that he needed.  It was evident from the conversation that he really gets LEAN, because he never once talked negatively about the clinicians or staff, only the processes that had failed him and his parents.

The conversation was empowering, because I could see the excitement my revelation had on him and the hope it sparked.  Yet it was daunting, because I need to take on the responsibility and the obligation to see through the changes that are necessary so that when my neighbor walks into a hospital that I have help transform he has as much confidence as when I walk onto a plane he has assembled!   

It’s day 3. General Motors is speaking. They pay for 1 percent of the health care delivered in the U.S. They say that they’ve conducted 400 kaizen events in hospitals to improve efficiency.
It’s clear from the talk that health care purchasers are a force to be reckoned with. At the same time, the question arises about how this can be reconciled with GM’s performance in LEAN and as a company in general.
It also raises the question about the purchaser/health care provider relationship. In a LEAN world, a message sent that is “we need to put pressure on health care” doesn’t seem productive. What would Toyota do?

Day 2 of the AHRQ conference, and a whole session on LEAN, featuring 3 organizations that are quite far along.
Excellent points were raised about the presence of a lot of hoopla, but not much research data. Should our government spend time and money to research this, or should we just do it?
The questions of the audience at the same time showed that we have along way to go.

Last night in a fit of insomnia I turned on the television and caught the tail end of a discussion on CNN Money about growth markets in the United States for the next ten years.  Two analysts, one from Wall Street and another that specializes in venture funding both said that the Healthcare Service Industry will be “hot.”  ’This market is approaching 20% of GDP and there is a lot of opportunity for the smart and the business savvy.’

So what does that mean for the organizations that are currently in this sector?  I think that is should be a wake up call.  When organizations like GE and Wal-Mart start entering the healthcare service market to satisfy investor demands they will bring business discipline, marketing expertise, and an incredible amount of cash.  If healthcare organizations don’t figure out how to improve quality, cost and service they will be in trouble, quickly.  Applying LEAN might be the only option to hold off this competition.