Table of Contents for Healthcare Kaizen : Engaging Front-Line Staff in Sustainable Continuous Improvements


Preface xix
Acknowledgments xxi
Mark Graban
Acknowledgments xxiii
Joe Swartz
Foreword xxv
Masaaki Imai
Introduction xxvii
Norman Bodek
About the Authors xxix
SECTION 1 WHAT IS KAIZEN?
1 Kaizen and Continuous Improvement
3(28)
Kaizen = Change for the Better
4(1)
Bubbles for Babies
5(1)
Kaizen: A Powerful Word
6(2)
Kaizen Is Not Just Change, It Is Improvement
8(1)
We Often Succeed as the Result of Failing More
8(1)
Kaizen, PDSA, and the Scientific Method for Improvement
9(2)
Changing Back Can Be Better for Babies
11(1)
Kaizen = Continuous Improvement
12(1)
Kaizen Starts with Small Changes
13(1)
A Small Kaizen with Great Meaning
14(1)
Kaizen = Engaging Everybody in Their Own Change
14(1)
Kaizen Upon Kaizen Upon Kaizen
15(1)
Kaizen Closes Gaps between Staff and Leaders
16(1)
Creativity before Capital
17(3)
Expensive Mistakes Made without the Kaizen Mindset
20(1)
Kaizen and Lean: Related and Deeply Interconnected Concepts
20(1)
People Are the Ultimate Competitive Advantage
21(1)
High-Level Kaizen Principles---The Kaizen Mindset
21(3)
Principle 1 Asking
22(1)
Principle 2 Empowering
23(1)
Principle 3 Recognizing
23(1)
Principle 4 Sharing
23(1)
This Is Not a Suggestion System---It Is an Improvement System
24(1)
Kaizen Has an Impact on People and Performance
24(3)
Conclusion
27(1)
Discussion Questions
27(1)
Endnotes
27(4)
2 The Roots and Evolution of Kaizen
31(18)
Early Suggestion Programs
31(1)
Downsides of Suggestion Box Programs
32(3)
Recovering from Taylorism
35(2)
The American Roots of Continuous Improvement---TWI and Deming
37(3)
Kaizen: One of the Two Pillars of The Toyota Way
40(2)
Masaaki Imai and the Spread of Kaizen (1986)
42(2)
Dr. Donald M. Berwick's Call for Kaizen (1989)
44(1)
"Medicine's Need for Kaizen" (1990)
45(1)
Norman Bodek and American Kaizen
45(1)
Conclusion
46(1)
Discussion Questions
46(1)
Endnotes
47(2)
3 Types of Kaizen
49(22)
The Continuous Improvement of a Lifesaving Innovation
50(1)
Three Levels of Kaizen
51(6)
Imai's Three Levels of Kaizen
55(1)
Complementary Nature of the Levels of Kaizen
55(1)
Three Types of Kaizen at Children's Medical Center Dallas
56(1)
Events Alone Will Not Make You Lean
57(9)
The Origins of Kaizen Events
57(1)
Basic Structure and Format of an Improvement Event
58(1)
Additional Challenges with Weeklong Events
59(1)
Impressive Results from Kaizen in Healthcare
60(1)
Virginia Mason Medical Center
60(2)
ThedaCare
62(2)
Not All Kaizen Organizations Use Events
64(1)
Avera McKennan Uses System Kaizen and Daily Kaizen
64(1)
Kaizen Leads to Innovation at Franciscan
65(1)
Conclusion
66(1)
Discussion Questions
67(1)
Endnotes
67(4)
4 Moving Toward a Kaizen Culture
71(28)
The Real Goal---Cultural Transformation
71(2)
What a Kaizen Culture Feels Like
73(3)
Everyone Is Engaged
73(2)
Drivers of Engagement
75(1)
Everyone Is Relentlessly Searching for Opportunities to Improve
76(2)
The Two Parents of Transformation: Pain and Possibility
78(15)
Pain
78(1)
Possibilities
79(1)
You Have Control over Your Workplace
80(1)
Patients and Families Are Happy
81(3)
Staff and Physicians Are Happy
84(2)
Work and Patient Care Flow Like Clockwork
86(1)
The Workspace Is Clean, Orderly, and Safe
86(1)
Everyone Works Together
87(3)
Everything Gets Questioned
90(1)
Small Successes Lead to Bigger Successes
90(3)
Imai's Three Stages of Kaizen
93(1)
Conclusion
94(1)
Discussion Questions
94(1)
Endnotes
95(4)
SECTION 2 KAIZEN METHODOLOGIES
5 Quick and Easy Kaizen
99(38)
How to Do Kaizen
99(1)
Quick and Easy Kaizen
100(2)
Starting the Franciscan Kaizen Journey
102(1)
The Quick and Easy Kaizen Process
102(31)
Step 1 Find
103(1)
Start Small
103(1)
Start with You
103(1)
Make Your Work Easier
103(2)
Make Your Work Safer
105(1)
Make Your Work More Interesting
105(1)
Build Your Skills, Your Capabilities, and Your Knowledge
106(1)
See an Opportunity or a Problem
106(6)
Step 2 Discuss
112(1)
Discuss with Your Direct Supervisor
112(3)
Discuss with Your Team Members
115(8)
Step 3 Implement
123(1)
Enrolling Others to Help
123(1)
Implement the Improvement Idea
124(1)
Seven Days Grace
124(1)
Step 4 Document
125(1)
Finalize the Kaizen Report
126(3)
Submit Report for Approval
129(1)
Step 5 Share
130(1)
Leveraging Improvement Ideas from Others
130(1)
Sharing Kaizens
131(2)
Conclusion
133(1)
Discussion Questions
134(1)
Endnotes
135(2)
6 Visual Idea Boards
137(38)
Making the Improvement Process Visible
138(2)
Setting up a Visual Idea Board
140(3)
Boards Should Be Highly Visible in the Workplace
141(1)
Boards in Public Settings
142(1)
Communication before the Visual Idea Board Is Up
143(1)
What Happened to Our Suggestion Box?
143(1)
What Employees Can Expect
143(1)
A Communication Example
144(1)
Formats for Idea Cards
144(4)
Sticky Notes versus Structured Cards
144(2)
Idea Cards versus Suggestion Cards
146(1)
Modeling the Kaizen and PDSA Process in Writing
147(1)
Visual Idea Cards
148(7)
Problem
148(1)
Suggestion or Idea
149(1)
Date Originated
150(1)
Created by
150(1)
Expected Benefits
150(3)
Input Needed from
153(1)
Implementation Steps
153(1)
Results Verified?
154(1)
New Method Standardized?
155(1)
Completion Date
155(1)
Idea Card Examples
155(5)
Staff and Patient Annoyances
155(1)
Asking for Help
155(2)
Addressing Patient Needs
157(2)
Getting Input from Others
159(1)
Other Formats of Idea Boards and Cards
160(5)
Park Nicollet's KEEP Form
160(3)
Akron Children's Hospital
163(1)
Seattle Children's Hospital Pharmacy
163(2)
Visual Management of the Idea Boards
165(4)
Using Idea Cards to Coach People on Kaizen
169(3)
The Suggestion to "Be More Careful"
170(1)
Something's Not Happening---So Don't Forget
171(1)
Easier for Us, but Not Best for the Whole System?
171(1)
Tracking Completed Cards
172(2)
Conclusion
174(1)
Discussion Questions
174(1)
Endnotes
174(1)
7 Sharing Kaizen
175(34)
Different Formats for Sharing
175(1)
The Kaizen Wall of Fame Format
176(2)
Kaizen Sharing Examples
178(29)
Making Things Better for Patients
179(1)
Supplies for Patients
180(1)
Improving Meal Rounds
181(1)
Easier to Get DVDs
182(1)
Little Details for Patients
183(1)
Preventing Mistakes or Harm
183(1)
Ensuring Proper Bed Cleaning
184(1)
Preventing Pressure Ulcers
185(1)
More Accurate Lab Results through Standardized Work
186(1)
Proper X-Ray Ordering
187(1)
Ensuring Equipment Is Ready
188(2)
Eye Protection for Lab Staff
190(1)
Preventing Aerosolized Specimens
191(1)
Making Work Easier for Staff
192(1)
Easier to Plug In Carts
192(1)
Improved Ergonomics and Specimen Quality
193(1)
Saving Sore Feet
194(1)
Better Phone Ergonomics and Productivity
195(1)
Combining Two Forms into One
196(1)
Preventing Delays
197(1)
Faster Code STEMI Heart Attack Care
197(1)
Meds for Discharged Patients
198(1)
Getting Patients to Rooms with Less Delay
199(1)
More Timely Test Results for Rounding
200(1)
Fewer Supply Chain Delays
200(1)
Better Access to Endocrinology
200(3)
Saving Space or Cost
203(1)
Creativity over Capital in the Lab
203(1)
Company Medical Clinic Costs
204(2)
Rethinking Freezer Use
206(1)
Conclusion
207(1)
Discussion Questions
207(2)
8 The Art of Kaizen
209(26)
Barriers to Kaizen
210(3)
Resistance to Change
211(1)
Lack of Time---We're Too Busy
212(1)
A Model for Mobilizing Support
213(7)
Tenet 1 Respect Others
214(1)
Tenet 2 Create a Vision That Matters
215(1)
Tenet 3 Convey the Why
216(3)
Tenet 4 Connect to the Mission
219(1)
Is This about Me or Is This about the Mission?
220(1)
Working with Others Based on Their Willingness to Invest
220(8)
Strategy 1 Co-create with Those Eager for Opportunity
221(1)
Seek Their Ideas
222(1)
Play Kaizen Catch Ball
222(1)
Reigniting Everyone's Creativity
223(1)
Strategy 2 Sell Opportunity to Those Who Are Cautious
224(1)
Encourage
225(1)
Seven Days' Grace
225(1)
Measure Progress
225(1)
Strategy 3 Find Common Meaning and Negotiate with Opposers
226(1)
Include Opposing Viewpoints
226(1)
Find Common Meaning
227(1)
Negotiate
227(1)
Use Demands as a Last Resort
228(1)
Kaizen and Positive Deviance
228(2)
Rules for Leaders
229(1)
Conclusion
230(1)
Discussion Questions
230(1)
Endnotes
230(5)
SECTION 3 KAIZEN LESSONS LEARNED
9 The Role of Leaders in Kaizen
235(36)
Leading to Create the Culture
236(1)
Key Actions for Leaders at All Levels
236(6)
Key Action 1 Believe In the Power of Kaizen
237(1)
Key Action 2 Participate in Kaizen
237(1)
Key Action 3 Just Ask
238(1)
Ask, Don't Tell
238(1)
Key Action 4 Use Kaizen to Develop People
239(1)
Key Action 5 Ensure Staff Members Are Recognized and Rewarded
240(1)
Key Action 6 Share and Spread Ideas
240(1)
Key Action 7 Sell the Benefits
241(1)
It Is Not Always about Cost
241(1)
Role of Top-Level Managers
242(7)
Leadership and Kaizen Participation Starts at the Top
242(1)
Dr. John Toussaint's Participation
242(2)
Going to the Gemba
244(1)
Kaizen Reports Are for Everybody
244(1)
Key Actions for Top-Level Managers
244(1)
Key Action 1 Communicate Expectations and Prioritize
244(2)
Key Action 2 Resource Adequately
246(1)
Key Action 3 Sponsor a Recognition and Incentives Program
247(1)
Key Action 4 Share Notable Kaizens
247(2)
Key Action 5 Thank People Personally
249(1)
Role of Middle-level Managers
249(11)
Paula's Baby Steps Lead the Way
250(1)
The "Great Big Pile of Problems"
250(1)
Leaders Drive Kaizen Success
251(1)
The Kaizen Difference
252(1)
Key Actions for Middle-level Managers
253(1)
Key Action 1 Be the Departmental Owner and Develop Co-Owners or Coordinators
253(1)
Key Action 2 Use Departmental Meetings
254(1)
Key Action 3 Encourage Staff to Participate by Asking for Their Ideas
255(1)
Key Action 4 Create a Departmental Recognition System
255(3)
Key Action 5 Put a Tracking System in Place, if One Does Not Exist
258(1)
Key Action 6 Tie to Performance Evaluations
259(1)
Role of First-Level Managers
260(8)
A First-Level Manager Is a Coach
260(1)
Key Actions for First-Level Managers
261(1)
Key Action 1 Coach
261(1)
Key Action 2 Empower Staff---Do Not Do the Kaizen for Them
262(1)
Key Action 3 Use Rounding to Coach
262(1)
Key Action 4 Help Set Expectations
263(1)
Key Action 5 Review and Approve Kaizen Reports
263(2)
Key Action 6 Help Document Benefits
265(1)
Key Action 7 Make Kaizen Fun
265(1)
Key Action 8 Recognize and Reward
266(1)
Key Action 9 Share and Spread Ideas
266(1)
Key Action 10 Be a Cheerleader
267(1)
Conclusion
268(1)
Discussion Questions
268(1)
Endnotes
268(3)
10 Organization-Wide Kaizen Programs
271(22)
Getting Started
271(3)
When Will You See Results?
272(1)
Tying Kaizen to the Organization's Strategy
273(1)
The Kaizen Promotion Office
274(1)
Staffing the KPO
274(1)
Activities of the Kaizen Promotion Office
275(4)
Activity 1 Facilitates the Practice of Kaizen
275(1)
Activity 2 Reports Kaizen Metrics
276(1)
Activity 3 Coordinates Rewards and Recognition
277(1)
Activity 4 Facilitates Kaizen Sharing across the Organization
278(1)
Activity 5 Develops Kaizen Standardized Work
278(1)
Activity 6 Develops and Delivers Staff Education
279(1)
Activity 7 Facilitates the Documentation and Tracking of Kaizens
279(1)
Sustaining a Kaizen Program---Incentives and Rewards
279(2)
Pros and Cons of Financial Incentives
280(1)
Electronic Kaizen Systems
281(8)
Advantages of an Electronic Online Database
282(1)
Quick Entry
282(2)
Automatic Routing and Electronic Approval
284(1)
Ideas to Hold for Later
285(1)
Quick Search and Retrieval
285(1)
Electronic Kaizen within Intermountain Healthcare
285(1)
Electronic Kaizen at Park Nicollet
286(1)
Electronic Kaizen at Vanderbilt
287(2)
Conclusion
289(1)
Discussion Questions
290(1)
Endnotes
290(3)
11 Lean Methods for Kaizen
293(42)
Technique 1 Add Value
293(4)
The Internal Customer's Point of View
294(1)
Different Forms of Patient Value
295(2)
Technique 2 Eliminate Waste
297(6)
Waste 1 Transportation
298(1)
Waste 2 Overproduction
298(1)
Waste 3 Motion
299(1)
Waste 4 Defects (Errors and Rework)
300(1)
Waste 5 Waiting
300(1)
Waste 6 Inventory
300(1)
Waste 7 Overprocessing
301(1)
Waste 8 Lost Human Potential, Creativity, and Opportunities
301(1)
Seeing Waste through Process Observation
302(1)
"Go See"
302(1)
Spaghetti Diagrams
303(1)
Technique 3 Visual Workplace
303(7)
Color Coding
306(2)
Home Locations
308(1)
Kitchen Example
308(1)
Borders
309(1)
Technique 4 5S---Workplace Organization
310(5)
S1 Sort
310(1)
S2 Set in Order
311(1)
S3 Shine
312(1)
S4 Standardize
312(1)
S5 Sustain
313(2)
Technique 5 Workstation Design
315(1)
Technique 6 Problem Solving
316(6)
A3 Problem-Solving Technique
317(2)
Problem-Solving Methods Used with A3
319(1)
Find the Point of the Cause
319(2)
Identify the Root Cause
321(1)
Technique 7 Error Proofing
322(9)
Fatal and Preventable Healthcare Errors
324(2)
Four Elements of a Zero Defect Quality System
326(1)
Element 1 Self-Check and Successive Check
326(1)
Element 2 Immediate Feedback and Corrective Action
326(1)
Element 3 Source Inspection
326(4)
Element 4 100% Inspection
330(1)
Conclusion
331(1)
Discussion Questions
332(1)
Endnotes
332(3)
12 Kaizen At Home
335(24)
Kaizen Tips from an Actress
335(1)
Kaizen Tips from a Behavioral Scientist
336(1)
Kaizen at Home
337(1)
Kaizen before Work
337(10)
Kaizen for Breakfast
337(1)
Kaizen to Get Ready for Work
338(1)
Kaizen with Your Coffee
338(2)
Kaizen to Get Dressed
340(6)
Kaizen to Reduce Cup Clutter
346(1)
Kaizen on the Way to Work
346(1)
Kaizen in the Home Office
347(2)
Kaizen on the Computer
347(1)
Kaizen on the Physical Desktop
348(1)
Kaizen after Work
349(6)
Kaizen for Dinner
349(2)
Kaizen in the Backyard
351(1)
Improvements
351(1)
Kaizen for Home Repair
351(1)
Kaizen for the Earth
352(1)
Kaizen in the Bathroom
352(1)
Kaizen and Your Kids
353(1)
A Vacation from Kaizen?
354(1)
Kaizen for Repetitive Tasks
354(1)
Kaizen for the Kaizen Process
355(1)
Conclusion
355(1)
Discussion Questions
356(1)
Endnotes
356(3)
Conclusion
359(4)
A Minute to Learn, a Lifetime to Master
360(1)
Your Next Steps
360(1)
Building a Kaizen Community
361(1)
Endnotes
361(2)
Index 363