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