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 “Just Do Its” & Problem Solving © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Problems & Opportuni)es © 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 Dme – Don’t stop asking • Lead by example – parDcipate – 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 paDent 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 © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Source: Healthcare Kaizen Before / Amer Data from CMC Lab Before Lean 12 Months After Starting Lean I have the opportunity to what I best every day 3.11 3.92 I feel free to make suggestions for improvement 2.84 3.48 10 I feel secure in my job 17 I am satisfied with the lab as a place to work 2.32 2.43 2.51 3.42 3.23 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 13 Stress at work is manageable © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved KaiNexus Data / Charts © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Whitepaper: hYp://bit.ly/KaiNexus Franciscan Par)cipa)on % People Par)cipa)ng 60% 50% 40% 30% 46% 56% 20% 10% 0% 2011 © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Since 2007 Source: Healthcare Kaizen # of Recorded Kaizens © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Source: Healthcare Kaizen Franciscan Savings Impact © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Source: Healthcare Kaizen Ideas vs Sugges)ons “ SuggesDons 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: mark@LeanBlog.org Blog: www.LeanBlog.org Startup: www.KaiNexus.com TwiTer: www.twiYer.com/MarkGraban Books: – www.LeanHospitalsBook.com – www.HCkaizen.com • www.Hckaizen.com/kaizenpreview © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved [...]... 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... Healthcare Kaizen Improvements for NICU Moms (3) © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Source: Healthcare Kaizen Kaizen: Real, Daily, Visual (Visual Idea Board) © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Children’s Medical Center Dallas (Lab) Kaizen: Real, Daily, Visual (Electronic -‐ KaiNexus)... 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 © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Source: Healthcare Kaizen “Just... 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. .. 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... Joseph E Swartz All Rights Reserved Kaizen on Her FIRST Day © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Source: Healthcare Kaizen Kaizen “Wall of Fame” © 2012 Mark Graban and/or Joseph E Swartz All Rights Reserved Children’s Medical Center Dallas (Lab) Innova )on & Kaizen EHART Blood Pressure... 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,... 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... 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... 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