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Healthcare Kaizen:
                                                 The Suggestion Box is Dead


                                            Guest Presenter: Mark Graban




                                                                                         August	
  21,	
  2012	
  


©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
§ 	
  Founder,	
  Karen	
  MarEn	
  &	
  Associates,	
  LLC	
  
(1993).	
  
	
  

§ 	
  Lead	
  Lean	
  transformaEons	
  &	
  develop	
  people	
  in	
  
office,	
  service	
  and	
  knowledge	
  environments.	
  
	
  

§ 	
  Teach	
  at	
  University	
  of	
  California,	
  San	
  Diego’s	
  
Lean	
  Enterprise	
  program.	
  
	
  

§ 	
  Author:	
  


                                                                                                                Karen	
  Mar1n,	
  
                                                                                                                  Principal	
  




       ©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Mark	
  Graban	
  
•  Currently:	
  
    •  President,	
  Constancy,	
  Inc.	
  
    •  Faculty	
  member,	
  Lean	
  Enterprise	
  InsEtute	
  
    •  Chief	
  Improvement	
  Officer,	
  KaiNexus	
  

•  Author	
  of	
  Lean	
  Hospitals	
  (2008,	
  2011)	
  
    •  Shingo	
  Research	
  and	
  Professional	
  PublicaEon	
  
           Prize,	
  2009	
  
•  Co-­‐Author	
  of	
  Healthcare	
  Kaizen	
  (2012)	
  
    •  With	
  Joseph	
  E.	
  Swartz	
  
    	
  
    	
  
    	
  
    	
  
    	
  
    	
  
    	
  
•  BS	
  Industrial	
  Engineering,	
  Northwestern	
  University	
  
•  MS	
  Mechanical	
  Engineering	
  &	
  MBA,	
  MIT	
  

                                                                                                          www.leanblog.org	
  
 ©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
The	
  Sugges1on	
  Box	
  is	
  Dead!	
  
                                                                                                                 Mark	
  Graban	
  
                                                                                                                  President,	
  Constancy,	
  Inc.	
  
                                                                                                         Chief	
  Improvement	
  Officer,	
  KaiNexus	
  
                                                                                                           Faculty,	
  Lean	
  Enterprise	
  Ins1tute	
  

                                                                                                                        	
  
                                                                                                              August	
  21,	
  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.	
  	
  
Dysfunc1ons	
  of	
  Sugges1on	
  Systems	
  
       •         Slow	
  /	
  No	
  Response	
  
       •         Yes	
  /	
  No	
  Answers	
  
       •         Not	
  CollaboraEve	
  
       •         Not	
  Transparent	
  
       •         Buy	
  Instead	
  of	
  Do?	
  
       •         Complaints	
  Against	
  Others	
  
       •         IncenEves	
  à	
  FighEng	
  
       •         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	
  BeRer	
  	
  


      •  ‘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                                                                                                 System
                                                                                                                       Kaizen


                                                                       Six
                                                                     Sigma
          Few                                                        Project
          Medium issues
                                                                                                               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	
  
     produc1vity.	
  	
  Improvements	
  and	
  
     sugges1ons	
  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-­‐
          boos1ng	
  benefits	
  and	
  
          posi1ve	
  employee	
  
          par1cipa1on	
  over	
  the	
  
          economic	
  and	
  financial	
  
          incen1ves…”	
  	
  
          -­‐	
  Masaaki	
  Imai	
  




©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Dr.	
  Berwick’s	
  	
  
                                                         Call	
  for	
  Kaizen	
  (1989)	
  

  	
  


  •  Kaizen	
  =	
  “the	
  conEnuous	
  search	
  for	
  
     opportuniEes	
  for	
  all	
  processes	
  to	
  get	
  beger”	
  
  	
  
  	
  
  •             Dr.	
  Donald	
  Berwick	
  
                 –      Founder,	
  InsEtute	
  for	
  Healthcare	
  Improvement	
  
                 –      Former	
  Administrator,	
  Medicare	
  and	
  Medicaid	
  (CMS)	
  




            CitaEon:	
  Berwick,	
  DM,	
  “ConEnuous	
  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	
  	
  
Fear	
  of	
  Layoffs	
  




                                                                                                         Found	
  posted	
  in	
  a	
  hospital	
  lab	
  (during	
  ini9al	
  Lean	
  assessment)	
  
©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
     Source	
  unknown	
  
“No	
  Layoffs	
  Due	
  to	
  Lean”	
  




©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
We	
  Don’t	
  Have	
  Time?	
  

      “Mikki	
  Gremp,	
  RN,	
  lel	
  one	
  
      hospital	
  because	
  a	
  number	
  
      of	
  policies,	
  including	
  its	
  
      pracEce	
  of	
  'flexing	
  down,'	
  
      lel	
  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



©	
  2012	
  Mark	
  Graban	
  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	
  Prac1ces?	
  

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




                                                                                                         See	
  YouTube:	
  hgp://bit.ly/Support-­‐Create	
  
©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Joint	
  Commission	
  Now	
  Says…	
  
     “it	
  may	
  be	
  Eme	
  for	
  hospitals	
  
     to	
  move	
  away	
  from	
  best	
  
     prac1ces	
  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	
  pa1ent	
  
     safety	
  needs.”	
  
     	
  -­‐	
  Mark	
  Chassin,	
  MD,	
  President	
  
     	
  
©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
A	
  Proposed	
  Formula	
  




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




©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
“Quick	
  and	
  Easy”	
  Kaizen	
  
                                                                                                             Find	
  
       1.  Find	
  
       2.  Discuss	
                                                                                       Discuss	
  


       3.  Implement	
  
                                                                                                         Implement	
  
       4.  Document	
  
       5.  Share	
                                                                                       Document	
  



                                                                                                            Share	
  
©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Why	
  Kaizen?	
  
                                                                                                         Norman Bodek

                                                     1.  Make your work easier
                                                     2.  Make your work more
                                                         interesting
                                                     3.  Develop your skills &
                                                         capabilities




©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Start	
  Small	
  
       •  “There	
  are	
  no	
  big	
  problems,	
  there	
  
          are	
  just	
  a	
  lot	
  of	
  ligle	
  problems.”	
  	
  
                     –  Henry	
  Ford	
  	
  

       •         Make	
  your	
  job	
  easier	
  
       •         Save	
  a	
  few	
  seconds	
  
       •         Improve	
  paEent	
  care	
  or	
  service	
  
       •         Improve	
  safety	
  
       •         Reduce	
  waiEng	
  

©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Itera1ve	
  PDSA	
  Improvements	
  


                                                                                                                                                   Improvements




Ideas

                                                                                      One	
  improvement	
  olen	
  leads	
  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	
  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)	
  




©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Completed	
  “Idea	
  Card”	
  




©	
  2012	
  Mark	
  Graban	
  and/or	
  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)	
  
Innova1on	
  &	
  Kaizen	
  
             	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  EHART	
  Blood	
  Pressure	
  Cuffs	
  
                                              Before                                                                                  After
             Taking time digging through the bucket on top                                           Place a small strip of Velcro® brand hook and loop fasteners on the
             of the crash cart to try to find the correct size                                       wall with different sizes of BP cuffs. Staff is able to quickly visualize
             blood pressure cuffs. This can be problematic                                           the different sized cuff and get the proper size for the patient, and the
             during an EHART® when you want to get a                                                 blood pressure can be obtained quicker.
             blood pressure (BP) in a hurry so that you can
             get medications in the patients.




                                                                                                         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	
  Do	
  Its”	
  &	
  Problem	
  Solving	
  




©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Problems	
  &	
  Opportuni1es	
  




©	
  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	
  Eme	
  
               –  Don’t	
  stop	
  asking	
  
  •  Lead	
  by	
  example	
  –	
  parEcipate	
  
               –  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	
  paEent	
  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
       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
©	
  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:	
  hgp://bit.ly/KaiNexus	
  	
  
Franciscan	
  Par1cipa1on	
  
                                                                                     %	
  People	
  Par1cipa1ng	
  



                   60%	
  

                   50%	
  

                   40%	
  

                   30%	
                                                                                                       56%	
  
                                                                               46%	
  
                   20%	
  

                   10%	
  

                      0%	
  
                                                                     2011	
                                           Since	
  2007	
  

©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
     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.	
  Sugges1ons	
  
                                                                  “	
  SuggesEons	
  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	
  
   •               TwiRer:	
         	
  www.twiger.com/MarkGraban	
  
   •               Books:	
  
                  –  www.LeanHospitalsBook.com	
  
                  –  www.HCkaizen.com	
  
                      •  www.Hckaizen.com/kaizenpreview	
  



©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
  
Upcoming Webinars
             Date	
                                                                                      Topic	
  
    Thu	
  Aug	
  23	
                            Value	
  Stream	
  Mapping:	
  Think	
  Strategy	
  Before	
  TacEcs	
  
                                                  Rapid	
  Improvement:	
  How	
  to	
  Change	
  Behaviors	
  and	
  Get	
  Stuff	
  
    Thu	
  Sep	
  13	
  
                                                  Done	
  FAST	
  
      Thu	
  Oct	
  4	
                           Put	
  an	
  End	
  to	
  OrganizaEonal	
  ADD:	
  Create	
  Your	
  2012	
  Strategic	
  
                                                  Improvement	
  Plan	
  
     Thu	
  Nov	
  1	
                            We’ve	
  Had	
  it	
  All	
  Wrong:	
  Manage	
  Processes,	
  Not	
  People	
  
                                                                               	
  
                                                                               	
  
                                                                      858.677.6799	
  
                                                                   ksm@ksmar1n.com	
  
                                                                TwiRer:	
  @karenmar1nopex	
  
                                                Blog	
  &	
  newsleRer:	
  www.ksmar1n.com/subscribe	
  	
  




©	
  2012	
  Mark	
  Graban	
  and/or	
  Joseph	
  E.	
  Swartz.	
  All	
  Rights	
  Reserved.	
  	
                                           50	
  

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Healthcare Kaizen

  • 1. Healthcare Kaizen: The Suggestion Box is Dead Guest Presenter: Mark Graban August  21,  2012   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 2. §   Founder,  Karen  MarEn  &  Associates,  LLC   (1993).     §   Lead  Lean  transformaEons  &  develop  people  in   office,  service  and  knowledge  environments.     §   Teach  at  University  of  California,  San  Diego’s   Lean  Enterprise  program.     §   Author:   Karen  Mar1n,   Principal   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 3. Mark  Graban   •  Currently:   •  President,  Constancy,  Inc.   •  Faculty  member,  Lean  Enterprise  InsEtute   •  Chief  Improvement  Officer,  KaiNexus   •  Author  of  Lean  Hospitals  (2008,  2011)   •  Shingo  Research  and  Professional  PublicaEon   Prize,  2009   •  Co-­‐Author  of  Healthcare  Kaizen  (2012)   •  With  Joseph  E.  Swartz                 •  BS  Industrial  Engineering,  Northwestern  University   •  MS  Mechanical  Engineering  &  MBA,  MIT   www.leanblog.org   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 4. The  Sugges1on  Box  is  Dead!   Mark  Graban   President,  Constancy,  Inc.   Chief  Improvement  Officer,  KaiNexus   Faculty,  Lean  Enterprise  Ins1tute     August  21,  2012   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 5. ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 6. ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 7. Dysfunc1ons  of  Sugges1on  Systems   •  Slow  /  No  Response   •  Yes  /  No  Answers   •  Not  CollaboraEve   •  Not  Transparent   •  Buy  Instead  of  Do?   •  Complaints  Against  Others   •  IncenEves  à  FighEng   •  Quotas  à  Gaming   Builds  on  the  book  Ideas  are  Free!  by  Robinson  &  Schroeder   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 8. Kaizen  =  Change  for  the  BeRer     •  ‘Kai’  means  “change.”   •  ‘zen’  means  “good.”     ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 9. Kaizen is Not Just Events   Very few Large issues System Kaizen Six Sigma Few Project Medium issues 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.    
  • 10.        “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   produc1vity.    Improvements  and   sugges1ons  by  team  members  are   the  cornerstone  of  Toyota's  success.”   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 11. Kaizen  is  for  Everyone!   “…  emphasizes  morale-­‐ boos1ng  benefits  and   posi1ve  employee   par1cipa1on  over  the   economic  and  financial   incen1ves…”     -­‐  Masaaki  Imai   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 12. Dr.  Berwick’s     Call  for  Kaizen  (1989)     •  Kaizen  =  “the  conEnuous  search  for   opportuniEes  for  all  processes  to  get  beger”       •  Dr.  Donald  Berwick   –  Founder,  InsEtute  for  Healthcare  Improvement   –  Former  Administrator,  Medicare  and  Medicaid  (CMS)   CitaEon:  Berwick,  DM,  “ConEnuous  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.    
  • 13. Barriers  to  Kaizen?   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 14. Fear  of  Layoffs   Found  posted  in  a  hospital  lab  (during  ini9al  Lean  assessment)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source  unknown  
  • 15. “No  Layoffs  Due  to  Lean”   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 16. We  Don’t  Have  Time?   “Mikki  Gremp,  RN,  lel  one   hospital  because  a  number   of  policies,  including  its   pracEce  of  'flexing  down,'   lel  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 ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 17. 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.    
  • 18. Why  Not  Best  Prac1ces?   “People   support  what   they  create.”    -­‐  Margaret  J.  Wheatley   See  YouTube:  hgp://bit.ly/Support-­‐Create   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 19. Joint  Commission  Now  Says…   “it  may  be  Eme  for  hospitals   to  move  away  from  best   prac1ces  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  pa1ent   safety  needs.”    -­‐  Mark  Chassin,  MD,  President     ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 20. A  Proposed  Formula   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 21. Completed  Kaizen  Example   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 22. “Quick  and  Easy”  Kaizen   Find   1.  Find   2.  Discuss   Discuss   3.  Implement   Implement   4.  Document   5.  Share   Document   Share   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 23. Why  Kaizen?   Norman Bodek 1.  Make your work easier 2.  Make your work more interesting 3.  Develop your skills & capabilities ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 24. Start  Small   •  “There  are  no  big  problems,  there   are  just  a  lot  of  ligle  problems.”     –  Henry  Ford     •  Make  your  job  easier   •  Save  a  few  seconds   •  Improve  paEent  care  or  service   •  Improve  safety   •  Reduce  waiEng   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 25. Itera1ve  PDSA  Improvements   Improvements Ideas One  improvement  olen  leads  to  another   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 26. Improvements  for  NICU  Moms  (1)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 27. Improvements  for  NICU  Moms  (2)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 28. Improvements  for  NICU  Moms  (3)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 29. Kaizen:  Real,  Daily,  Visual   (Visual  Idea  Board)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Children’s  Medical  Center  Dallas  (Lab)  
  • 30. Kaizen:  Real,  Daily,  Visual   (Electronic  -­‐  KaiNexus)   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 31. Completed  “Idea  Card”   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 32. Kaizen  on  Her  FIRST  Day   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 33. Kaizen  “Wall  of  Fame”   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Children’s  Medical  Center  Dallas  (Lab)  
  • 34. Innova1on  &  Kaizen                        EHART  Blood  Pressure  Cuffs   Before After Taking time digging through the bucket on top Place a small strip of Velcro® brand hook and loop fasteners on the of the crash cart to try to find the correct size wall with different sizes of BP cuffs. Staff is able to quickly visualize blood pressure cuffs. This can be problematic the different sized cuff and get the proper size for the patient, and the during an EHART® when you want to get a blood pressure can be obtained quicker. blood pressure (BP) in a hurry so that you can get medications in the patients. 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    
  • 35. “Just  Do  Its”  &  Problem  Solving   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 36. Problems  &  Opportuni1es   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 37. What  Can  We  Do  as  Leaders?   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 38. ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 39. ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 40. What  Can  We  Do  as  Leaders?   •  Ask  for  Kaizen   –  Help  create  Eme   –  Don’t  stop  asking   •  Lead  by  example  –  parEcipate   –  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.    
  • 41. Asking  Every  Day   •  Are  there  any  problems   interfering  with  your   work?   •  With  paEent  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.    
  • 42. Coaching  on  Idea  Cards   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 43. 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 ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 44. KaiNexus  Data  /  Charts   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Whitepaper:  hgp://bit.ly/KaiNexus    
  • 45. Franciscan  Par1cipa1on   %  People  Par1cipa1ng   60%   50%   40%   30%   56%   46%   20%   10%   0%   2011   Since  2007   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 46. #  of  Recorded  Kaizens   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 47. Franciscan  Savings  Impact   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     Source:  Healthcare  Kaizen    
  • 48. Ideas  vs.  Sugges1ons   “  SuggesEons  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.    
  • 49. Q&A  /  Contact  Info   •  Email:    mark@LeanBlog.org   •  Blog:        www.LeanBlog.org     •  Startup:  www.KaiNexus.com   •  TwiRer:    www.twiger.com/MarkGraban   •  Books:   –  www.LeanHospitalsBook.com   –  www.HCkaizen.com   •  www.Hckaizen.com/kaizenpreview   ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.    
  • 50. Upcoming Webinars Date   Topic   Thu  Aug  23   Value  Stream  Mapping:  Think  Strategy  Before  TacEcs   Rapid  Improvement:  How  to  Change  Behaviors  and  Get  Stuff   Thu  Sep  13   Done  FAST   Thu  Oct  4   Put  an  End  to  OrganizaEonal  ADD:  Create  Your  2012  Strategic   Improvement  Plan   Thu  Nov  1   We’ve  Had  it  All  Wrong:  Manage  Processes,  Not  People       858.677.6799   ksm@ksmar1n.com   TwiRer:  @karenmar1nopex   Blog  &  newsleRer:  www.ksmar1n.com/subscribe     ©  2012  Mark  Graban  and/or  Joseph  E.  Swartz.  All  Rights  Reserved.     50