mark graban webinar - asq led, suggestion boxes & kaizen

© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

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


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


Kaizen = Change for the BeTer

•  ‘Kai’ means “change.”

•  ‘zen’ means “good.”


Kaizen is Not Just Events

Six Sigma Project

Adapted from: “The Toyota” Way Fieldbook, Liker and Meier

Very few Large issues

Few Medium issues

Many Small issues

System Kaizen

Lean Event

Daily Kaizen


“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.”


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


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.


Barriers to Kaizen?

Source: Healthcare Kaizen

© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Found posted in a hospital lab (during ini9al Lean assessment) Source unknown

Fear of Layoffs


“No Layoffs Due to Lean”


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 Journal of Nursing April 2008, Volume 108 Number 4, Pages 23 - 24


People Hate Change?

“People don’t resist change, they resist being changed.”

–  Peter Scholtes (1938-‐2009)


Why Not Best Prac)ces?

“People support what they create.” -‐ Margaret J. Wheatley

See YouTube: hYp://bit.ly/Support-‐Create


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, MD, President


A Proposed Formula


Completed Kaizen Example


“Quick and Easy” Kaizen

1. Find 2. Discuss 3.  Implement

4. Document

5. Share

Find

Discuss

Implement

Document

Share


Why Kaizen?

1.  Make your work easier 2.  Make your work more

interesting 3.  Develop your skills &

capabilities

Norman Bodek


Start 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


Itera)ve PDSA Improvements

One improvement ofen leads to another


Ideas

Improvements


Improvements for NICU Moms (1)



Kaizen: Real, Daily, Visual (Visual Idea Board)

Children’s Medical Center Dallas (Lab)


Kaizen: Real, Daily, Visual (Electronic -‐ KaiNexus)


Completed “Idea Card”


Kaizen on Her FIRST Day



Kaizen “Wall of Fame”

Children’s Medical Center Dallas (Lab)


EHART Blood Pressure Cuffs

Before After

Taking time 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 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

Innova)on & Kaizen



“Just Do Its” & Problem Solving


Problems & Opportuni)es


What Can We Do as Leaders?


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


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?


Coaching on Idea Cards



Before / Amer Data from CMC Lab Before Lean 12 Months

After Starting Lean

3. I have the opportunity to do what I do best every day. 3.11 3.92 8. I feel free to make suggestions for improvement. 2.84 3.48 10. I feel secure in my job. 2.32 3.42 13. Stress at work is manageable. 2.43 3.23 17. I am satisfied with the lab as a place to work. 2.51 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


KaiNexus Data / Charts

Whitepaper: hYp://bit.ly/KaiNexus


Franciscan Par)cipa)on

0%

10%

20%

30%

40%

50%

60%

2011 Since 2007

46% 56%

% People Par)cipa)ng



# of Recorded Kaizens



Franciscan Savings Impact



Ideas vs. Sugges)ons

“ SuggesDons are things I think you should do… Ideas are things that I can do.”

-‐ Norman Bodek


Q&A / Contact Info •  Email: [email protected] •  Blog: www.LeanBlog.org •  Startup: www.KaiNexus.com •  TwiTer: www.twiYer.com/MarkGraban •  Books:

– www.LeanHospitalsBook.com – www.HCkaizen.com

• www.Hckaizen.com/kaizenpreview

mark graban webinar - asq led, suggestion boxes & kaizen

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