1st Edition

The Executive Guide to Healthcare Kaizen Leadership for a Continuously Learning and Improving Organization

By Mark Graban, Joseph E. Swartz Copyright 2014
    200 Pages 17 B/W Illustrations
    by Productivity Press

    200 Pages
    by Productivity Press

    Hospitals and health systems are facing many challenges, including shrinking reimbursements and the need to improve patient safety and quality. A growing number of healthcare organizations are turning to the Lean management system as an alternative to traditional cost cutting and layoffs. "Kaizen," which is translated from Japanese as "good change" or "change for the better," is a core pillar of the Lean strategy for today’s best healthcare organizations.

    Kaizen is a powerful approach for creating a continuously learning and continuously improving organizations. A Kaizen culture leads to everyday actions that improve patient care and create better workplaces, while improving the organization’s long-term bottom line. The Executive Guide to Healthcare Kaizen is the perfect introduction to executives and leaders who want to create and support this culture of continuous improvement.

    The Executive Guide to Healthcare Kaizen is an introduction to kaizen principles and an overview of the leadership behaviors and mindsets required to create a kaizen culture or a culture of continuous improvement. The book is specifically written for busy C-level executives, vice presidents, directors, and managers who need to understand the power of this methodology.

    The Executive Guide to Healthcare Kaizen shares real and practical examples and stories from leading healthcare organizations, including Franciscan St. Francis Health System, located in Indiana. Franciscan St. Francis’ employees and physicians have implemented and documented 4,000 Kaizen improvements each of the last three years, resulting in millions of dollars in hard savings and softer benefits for patients and staff.

    Chapters cover topics such as the need for Kaizen, different types of Kaizen (including Rapid Improvement Events and daily Kaizen), creating a Kaizen culture, practical methods for facilitating Kaizen improvements, the role of senior leaders and other leaders in Kaizen, and creating an organization-wide Kaizen program.

    The book contains a new introduction by Gary Kaplan, MD, CEO of Virginia Mason Medical Center in Seattle, Washington, which was named "Hospital of the Decade" in 2012.

    The Executive Guide to Healthcare Kaizen is a companion book to the larger book Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements (2012). Healthcare Kaizen is a longer, more complete "how to" guide that includes over 200 full color images, including over 100 real kaizen examples from various health systems around the world. Healthcare Kaizen was named a recipient of the prestigious Shingo Professional Publication and Research Award.

    Check out what the experts at the Franciscan St. Francis Health System have to say about Healthcare Kaizen.


    The Need for Kaizen
    Quick Take
    Kaizen = Change for the Better
    Kaizen = Meaningful Improvements
    Healthcare’s Opportunity for Improvement
    The IOM’s Recommendations for Continuous Learning
    Dr. Berwick’s Early Call for Kaizen in Healthcare
    The Impact of Kaizen at Franciscan St. Francis
         It Is Not Always about Cost
    The Business Case for Kaizen
         Lower Staff Turnover Costs
         Cost Reductions and Hard Savings
         Higher Revenue and Patient Throughput
         Cost Avoidance and Soft Savings     
         Improved Quality and Patient Safety
         Improvements Have Interwoven Results
    What Executives Need to Do
         Creating a Management Operating System
         Tying Kaizen to Strategy
         Connecting Kaizen to the Mission
    Discussion Questions

    What Is Kaizen?
    Quick Take
    Bubbles for Babies
    Kaizen = Continuous Improvement
    Kaizen Is Not Just Change, It Is Improvement
    Kaizen Starts with Small Changes
         A Small Kaizen with Great Meaning
    Kaizen Involves the People Who Do the Work
    Kaizen, PDSA, and the Scientific Method for Improvement
    We Often Succeed as the Result of Failing More
         "Failure" Should Result in Learning
         Changing Back Can Be Better for Babies
    Kaizen Is Not a Suggestion System—It Is an Improvement System
    Common Dysfunctions of Suggestion Systems
         Suggestion Boxes Are Rarely or Never Opened
         Suggestion Box Systems Are Slow, with Poor Feedback
         Too Many Suggestions Are Rejected or Ignored
         Suggestion Systems Put the Burden on Managers
         Winner Takes All Demoralizes the Rest
         Suggestion Bonuses Cause More Trouble than They Are Worth
    Kaizen and Lean
    Kaizen: One of the Two Pillars of The Toyota Way and Lean
         Respect for People = No Layoffs Due to Kaizen
         Kaizen and Respect Are Intertwined
    Kaizen Closes Gaps between Staff and Leaders
    Kaizen Values Creativity before Capital
    Kaizen Helps Avoid Expensive Mistakes
    Kaizen Reignites Our Inherent Creativity
    People Are the Ultimate Competitive Advantage
    Discussion Questions

    Types of Kaizen
    Quick Take
    The Continuous Improvement of a Lifesaving Innovation
    Kaizen Means Continuous Improvement or Just Projects?
    Three Levels of Kaizen
         Large Projects
         Mid-Sized Projects
         Smaller, Daily Improvements
         Complementary Nature of the Levels of Kaizen
    Three Types of Kaizen at Children’s Medical Center Dallas
    Events Are Powerful, but Not Enough
         Basic Structure and Format of an Improvement Event
         Additional Challenges with Weeklong Events
    Combining Different Types of Kaizen
         Virginia Mason Medical Center
         Avera McKennan
         Kaizen Leads to Innovation at Franciscan
    Discussion Questions

    Creating a Kaizen Culture
    Quick Take
    Everyone Is Part of the Change Culture
    The Real Goal—Cultural Transformation
         Kaizen Grows Skills and Abilities
    Barriers to Kaizen
         Resistance to Change
         Lack of Time—We’re Too Busy
    What a Kaizen Culture Feels Like
         Everyone Is Engaged
              Drivers of Engagement
         Everyone Is Relentlessly Searching for Opportunities to Improve
         Patients and Families Are Happy
         Staff and Physicians Are Engaged
         The Workspace Is Clean, Orderly, and Safe
         Everyone Works Together
         Everything Gets Questioned
         Small Successes Lead to Bigger Successes
    Imai’s Three Stages of a Kaizen Culture
    Discussion Questions

    Daily Kaizen Methods
    Quick Take
    Fresh Eyes Can See Waste That Hid before Your Eyes
    The 5 Steps of Kaizen
         Step 1: Find
              Start Small
         Step 2: Discuss
              Say "Yes"
              Coaches for Coaches
         Step 3: Implement
              Seven Days Grace
         Step 4: Document
              Quantifying Benefits When Possible
         Step 5: Share
    Sharing Kaizens: Kaizen Reports and the Kaizen Wall of Fame
    Visual Idea Boards: Making the Entire Kaizen Visible
         Idea Cards
    Electronic Kaizen Systems: Making Kaizen More Broadly Visible
         Advantages of an Electronic Online Database
              Quick Entry and Categorization
              Automatic Routing and Electronic Communication
              Quick Search and Retrieval
         Electronic Kaizen within Intermountain Healthcare
         Electronic Kaizen at Vanderbilt
    Discussion Questions

    The Role of Senior Leaders in Kaizen
    Quick Take
    The Reluctant CEO
    Key Actions for Leaders at All Levels
         Key Action 1: Believe in the Power of Kaizen
         Key Action 2: Participate in Kaizen
         Key Action 3: Just Ask
              Ask, Don’t Tell
         Key Action 4: Use Kaizen to Develop People
         Key Action 5: Ensure Staff Members Are Recognized and Rewarded
         Key Action 6: Share and Spread Ideas
         Key Action 7: Sell the Benefits
    The Specific Role of Senior Leaders
         Leadership and Kaizen Participation Starts at the Top
              Going to the Gemba
         Key Actions for Senior Leaders
              Key Action 1: Communicate Expectations, Prioritize, and Set Direction
              Key Action 2: Ensure Adequate Resources Are Available
              Key Action 3: Sponsor a Recognition and Incentives Program
              Key Action 4: Share Notable Kaizens
              Key Action 5: Thank People Personally
    Discussion Questions

    The Role of Other Leaders in Kaizen
    Quick Take
    From Cop to Coach
    Kaizen Requires Leaders at All Levels
    Role of Middle-Level Managers
         Paula’s Baby Steps Lead the Way
              The "Great Big Pile of Problems"
         Key Actions for Middle-Level Managers
              Key Action 1: Be the Departmental Owner and Develop Co-Owners or Coordinators
         Key Action 2: Use Departmental Meetings
         Key Action 3: Encourage Staff to Participate by Asking for Their Ideas
         Key Action 4: Create a Departmental Recognition System
         Key Action 5: Put a Tracking System in Place, if One Does Not Exist
         Key Action 6: Tie to Performance Evaluations
    Role of First-Level Managers
         Key Actions for First-Level Managers
              Key Action 1: Coach
         Key Action 2: Empower Staff—Do Not Do the Kaizen for Them
         Key Action 3: Use Rounding to Coach
         Key Action 4: Help Set Expectations
         Key Action 5: Review and Approve Kaizen Reports
         Key Action 6: Help Document Benefits
         Key Action 7: Make Kaizen Fun
         Key Action 8: Recognize and Reward
         Key Action 9: Share and Spread Ideas
         Key Action 10: Be a Cheerleader
    Leaders Drive Kaizen Success
    Discussion Questions

    Organization-Wide Kaizen Programs
    Quick Take
    From Helplessness to Empowerment
    From One Department to the Whole Organization
    Getting Started
         Starting Small and Spreading Kaizen
         When Will You See Results?
         Tying Kaizen to the Organization’s Strategy
    The Kaizen Promotion Office
         Staffing the KPO
    Activities of the Kaizen Promotion Office
         Activity 1: Facilitates the Practice of Kaizen
         Activity 2: Reports Kaizen Metrics
         Activity 3: Coordinates Rewards and Recognition
         Activity 4: Facilitates Kaizen Sharing across the Organization
         Activity 5: Develops Kaizen Standardized Work
         Activity 6: Develops and Delivers Staff Education
         Activity 7: Facilitates the Documentation and Tracking of Kaizens
    Sustaining a Kaizen Program: Incentives and Rewards
         Pros and Cons of Financial Incentives
    Discussion Questions

    Small Methods Lead to a Meaningful Impact
         Tools and Philosophies
         Building the Culture
    A Minute to Learn, a Lifetime to Master
    Building upon Franciscan’s Success
    Your Next Steps
    Building a Kaizen Community


    Mark Graban, Joseph E. Swartz

    I believe that Kaizen is essentially a 'human business.' Management must meet diversified requirements of its employees, customers, stakeholders, suppliers, and its community. In this sense, the healthcare profession can probably best benefit from Kaizen because its central task is people. I am honored to write the foreword to Healthcare Kaizen by Mark Graban and Joseph Swartz.
    —Masaaki Imai, author of KAIZEN and Gemba Kaizen

    To get started with Kaizen, you should do the following. First, read this book. Second, ask your employees to read the book. Third, ask your employees to begin a Kaizen system. It is just that simple. You just ask, and you will get what you ask for. Just do it and learn from the process.
    —Norman Bodek, author of How to do Kaizen and The Harada Method

    I hope you will discover, as we have, the incredible creativity that can be derived by engaging and supporting each and every employee in improvements that they themselves lead.
    —Robert J. (Bob) Brody, CEO, Franciscan St. Francis Health

    At a time when many hospitals and health systems have relegated Lean to the 'Project of the Month Club', Graban and Swartz remind us of the fundamentals that help organizations keep their Lean initiatives alive and thriving. I hope everyone reads this book and recommits to the fundamentals of Lean, particularly the involvement of frontline staff in process redesign.
    —Fred Slunecka, Chief Operating Officer, Avera Health

    Unleashing the energy and creativity of every employee to solve problems everyday should be the sole focus of every healthcare leader. Unfortunately, there are only a handful of examples where this is happening. Healthcare Kaizen provides examples of front line staff coming up with solutions to problems on their own and implementing them. Healthcare leaders need to read this book to understand that their management role must radically change to one of supporting daily kaizen if quality safety and cost are to improve in healthcare.
    —John Toussaint, MD, CEO, ThedaCare Center for Healthcare Value and author of On the Mend and Potent Medicine

    In Healthcare Kaizen, Mark Graban and Joseph Swartz show us that Kaizen is more than a set of tools. What we have learned through our application of the Virginia Mason Production System is that Kaizen is a management methodology of continuous improvement that must permeate the fabric of the entire organization. Front line staff must know, understand, embrace and drive Kaizen and its tools to achieve incremental and continuous improvements. This book will help health care organizations around the world begin and advance their journey.
    —Gary Kaplan, MD, FACP, FACMPE, FACPE, Chairman and CEO, Virginia Mason Medical Center

    The healthcare industry is in the midst of truly fundamental change, and those organizations that engage their front line staff in developing the strategies for improving care, enhancing satisfaction, and streamlining processes to reduce unnecessary variation and expense will be well positioned to thrive in a post-reform environment. In their book, Healthcare Kaizen, Graban and Swartz create a roadmap for using incremental, staff driven changes to inculcate performance improvement into the culture of an organization in a sustainable manner. This book represents a wonderful resource for healthcare leaders looking to foster innovation at all levels.
    Brett D. Lee, PhD, FACHE, CEO, Lake Pointe Health Network

    Healthcare Kaizen
    is a practical guide for senior healthcare leaders aspiring to engage frontline staff in true continuous improvement. Graban and Swartz skillfully illustrate how to foster and support daily continuous improvement in health care settings. Health systems struggle to move beyond improvement work being extra work done in "special projects" facilitated by experts. This book can guide organizational transformation so that continuous improvement becomes part of the daily work of frontline staff.
    —John E. Billi, MD, Associate Vice President for Medical Affairs, University of Michigan

    When healthcare organizations take initial steps on their Lean journey, they often focus very heavily on tools and grand solutions, which may create new barriers to innovation. In Healthcare Kaizen, Mark and Joe remind us of the great power of daily problem solving. Their examples reinforce that learning is a result of the repeated tests of changes that are often small and simple, and less often by hitting the home runs of improvement. The story of Franciscan St. Francis Health is compelling, where leaders created the opportunity for great people at the frontline making great improvements for patient care.
    —Michel Tétreault, MD, President and CEO, St. Boniface Hospital, Winnipeg, Canada
    —Bruce Roe, MD, Chief Medical Officer, St. Boniface Hospital, Winnipeg, Canada

    Without exception, the leadership of the health system is the determinant of success or failure in Lean transformation. The Executive Guide to Healthcare Kaizen is a focused and concise guide for that journey, a must-read for those who have that responsibility.
    —Dave Munch, MD, Senior Vice President and Chief Clinical Officer, Healthcare Performance Partners

    In the last decade, implementation of the Lean production model in a healthcare setting has produced remarkable outcomes and revolutionized the way we deliver care. Using examples from Franciscan Health and other forward-thinking medical groups, the book contains valuable strategies for organization-wide cultural transformation to create a more efficient, patient-centered healthcare system dedicated to continuous quality improvement.
    —Donald W. Fisher, PhD, President and CEO, American Medical Group Association

    Mark Graban and Joseph Swartz have brought to life the critical concept of kaizen – continuous improvement. In this latest edition, a great deal of emphasis is placed on senior management engagement and support of ongoing improvement. Most agree that meaningful, sustained change cannot occur without leadership from the top, engagement of the front lines, and cohesion of the leadership chain. This book does a wonderful job of delivering these important concepts in an accessible, intriguing manner. Kudos to Graban and Swartz!
    —Jody Crane, MD, MBA, Senior Medical Director, Stafford Hospital; Principal, X32 Healthcare; and co-author of The Definitive Guide to Emergency Department Operational Improvement

    Unfortunately the Lean movement has too often turned into a race to implement as many of the tools of Lean in as many places as possible. This is totally alien to the spirit of kaizen or the purpose of the Toyota Production System. The purpose is to create a culture of continuous improvement with people at all levels thinking deeply about their ideal vision for the people and process, and purposefully taking steps to achieve the vision. The vision should be for the good of the enterprise, not to check the box for the Lean folks who are auditing 5S and visual management.

    Mark and Joe have a deep understanding of the purpose of TPS and what is needed in healthcare to raise this from a program to a true culture that can tackle all the difficult challenges that face modern medicine. He has been steeped in the healthcare field for years and has great examples to illustrate kaizen, both small and big changes. In this book he takes on the challenge of driving kaizen down to the level of every work group--truly the deepest meaning of kaizen. This takes exceptional leadership, a second nature understanding of the tools, and always working at the gemba to solve the real problems. Hopefully this book will become a blueprint for healthcare organizations everywhere that truly want to be great!"
    —Jeffrey Liker, Professor of Industrial and Operations Engineering, University of Michigan; and Shingo Research Award-winning author of The Toyota Way

    It has been studied and shown that true north for healthcare organizations is an engaged senior leader and senior leadership team. This factor alone is the difference between mediocrity and excellence when it comes to performance and sustained extraordinary metrics for care, health and cost. The Executive Guide to Healthcare Kaizen provides a foundation for you as an executive to build the learning organization needed in today’s environment. Smart, to the point, and handy. You will find this guide invaluable.
    —Betty Brown, MBA MSN RN CPHQ FNAHQ, Immediate Past President of NAHQ; and Principal of ELLO Consulting, LLC

    At Beth Israel Deaconess Medical Center, everybody improving every day is a critical aspect of our Lean and quality improvement efforts. Healthcare Kaizen, is full of relatable examples as well as practical ideas that will inspire staff, clinicians and leaders at all levels. Its’ must-have supplement, The Executive Guide to Healthcare Kaizen: Leadership for a Continuously Learning and Improving Organization, clearly outlines the role of management in leading this important work. It is not enough to be supportive; rather, one must demonstrate genuine interest with active participation and not delegate continuous improvement to others.
    —Alice Lee, Vice President of Business Transformation, Beth Israel Deaconess Medical Center

    For the past 7 years I have been leading a successful Lean healthcare transformation at Chugachmiut, the non-profit organization I lead in Alaska. During that time, I have learned that respect for the people who work for you is key to any transformation. Mark Graban and Joseph Swartz do a great job of capturing this truth in their book, Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. Every employee can learn the tools of Lean, and improve processes as a result. However, sustaining a Lean transformation and resisting entropy requires engaging front line employees in a long term vision for serving their customers and in true continuous improvement. Employees who work in a culture that removes blame and shame, operates on facts and seeks improvement continuously have great leadership and will respond with incredible results. This book is a long needed addition to my growing Lean healthcare library.
    —Patrick M. Anderson, "Lean in Alaska" Governance and Management Consulting

    The term 'kaizen' has been interpreted in many ways since we learned of the Toyota Production System in healthcare. Mark and Joe demystify the term, help us understand its real meaning, and help us see how using kaizen can help us improve in healthcare and, frankly, how we can use kaizen to save lives. The philosophy, tools and techniques discussed in the book work, and work well, in any environment. We in healthcare must improve - we owe it to our patients and communities - and Mark and Joe are helping to show us the way.
    —Dean Bliss, Lean Improvement Advisor, Iowa Healthcare Collaborative

    The healthcare industry has long struggled to tap one of the biggest sources available to it for ideas to improve outcomes and reduce costs – its front-line staff. Healthcare Kaizen lays out a step-by-step approach that any healthcare organization can use to get the dramatic results that come when its workforce is fully engaged in kaizen activities on a daily basis. This inspirational book is packed with examples and is informed by the authors’ years of experience on the "front-lines" themselves, helping leading healthcare organizations around the world to build successful kaizen programs.
    —Alan G. Robinson, PhD, Professor, Isenberg School of Management at the University of Massachusetts; Co-author of Ideas Are Free and Corporate Creativity

    What Mark Graban and Joseph Swartz have done in Healthcare Kaizen and The Executive Guide to Healthcare Kaizen is to bring hope and light to a part of our society that is facing increasing challenges. Full of examples and illustrations from hospitals and healthcare professionals leading the way in the journey to patient-centered, error-free care delivery, this book makes it easy to connect with this very powerful concept of kaizen. By putting kaizen within the broader tradition of quality improvement, shedding light on its historical development and pointing out potential pitfalls in its application in healthcare, the authors provide a great service to the healthcare community. I was especially impressed by the authors’ important insights on what a kaizen culture feels like, and how people at all levels can and must engage in daily improvement. These books will be a reference on the subject for many years to come.
    Jon Miller, CEO of the Kaizen Institute

    Adoption of the Lean philosophy is dead on arrival without the involvement of an organization's senior leadership. Yet, what are members of the executive suite to think when a bunch of Japanese terms coming flying past their desk? And when the leadership philosophy required is something quite different from their training and experience? Graban and Swartz help cut through all this in a presentation that is cogent, efficient, and thoughtful. Whether you are new to Lean principles or experienced in them, this book has something to offer. Even if you don't choose to take the entire Lean journey, you will receive insights and ideas that will help you get better results from your organization.
    —Paul F. Levy, author of Goal Play! Leadership Lessons from the Soccer Field; and former CEO of Beth Israel Deaconess Medical Center