Monday, February 29, 2016


Kaizen is a Japanese word that can be translated to mean “good change,” “change for the better,” or “continuous improvement.” The methodology strives for, as Masaaki Imai says, “everybody improving, everywhere, and every day.” Toyota says the two pillars of its “Toyota Way” management system are continuous improvement and respect for people. These go hand in hand, as we are driven to improve because we respect our clients, staff, suppliers, and other stakeholders. A practice can achieve a culture of continuous improvement only by respecting and engaging everybody in improving and redesigning the way work is done.

It’s tempting for people to dream up large, expensive improvements. “We need to expand our parking lot” or “Give us better health benefits” might be two things suggested by employees. In a kaizen model, we are focused on small problems that we can solve within our span of control. Doctors and practice managers can ask staff to speak up about small problems that they encounter during the day - frustrations, annoyances, causes of delay and rework - and then ask for their ideas or “countermeasures” that could reduce waste or making things better in the practice. No idea is too small to be considered in the practice of kaizen. In fact, starting with small ideas can be a very effective way to get the process of culture change under way.

Kaizen improvements often involve low-cost and low-risk changes, putting “creativity before capital.” It’s not to say money should never be spent, but throwing money at problems or just asking for more resources doesn’t always solve problems in a sustainable way.

A kaizen process, it should be noted, is not managed like a traditional suggestion box system. Suggestion box systems have been dysfunctional for a number of reasons, including suggestions sitting in a box for weeks or months, a vast majority of ideas being rejected by management, and a disconnect between identifying suggestions and implementing them.

In a kaizen process, we start with a problem or opportunity statement followed by an idea, rather than starting with a solution. The role of management shifts from accepting and rejecting ideas to collaborating with staff to find a countermeasure that can work - solving the problem or, at least, making things a bit better. If an initial suggestion is impractical or too expensive, a practice manager should work with the employee and team to find something else to try. In a suggestion system, managers might get overburdened by having to implement everything themselves. In a kaizen process, staff and veterinarians play a major role in testing and evaluating ideas - but the practice needs to find ways to make time for improvement work.

In a simple and effective kaizen process, as explained more fully in the book Healthcare Kaizen, we follow five high-level steps:

  1. Find opportunities for improvement
  2. Discuss them with others
  3. Implement or test the idea (following the PDSA model)
  4. Document the before and after in a simple way
  5. Share what was implemented with colleagues and other offices

People everywhere can be creative, and that’s true in every role. With kaizen, we understand that the people doing the work are the experts in that work. Sure, managers and improvement specialists can play a role, but that role is more of a coach and facilitator instead of telling people what do. Creating a culture of continuous improvement requires the right leadership mindsets and behaviors.

In one practice the authors visited, an employee was cut badly by a sharp edge on a cabinet. Staff said that, on about 12 previous occasions, an employee had a minor scrape caused by that cabinet. In a kaizen culture, somebody would have spoken up to point out that problem, long before a serious injury occurred. Instead of downplaying the risk or saying “Well, don’t touch that edge,” a practice manager in a kaizen culture would work with staff to implement some countermeasure, such as putting a foam piece over the edge, that would reduce the risk of injury.

In a kaizen model, this problem and idea would be written down on a simple, standardized card. The card would be displayed visually and transparently on a bulletin board. The idea would be discussed informally or in a team huddle. Ownership would be assigned to an employee or small team, and they would then update the status of the improvement on the card. As improvements are implemented, if successful, protocols would be updated as needed and a simple “before and after” summary would be created and shared across the practice. In larger organizations with multiple practice locations, the “cloud” or software systems could be used to share and spread ideas more widely. If a practice in Dallas finds a problem and solves it, the other practice location in Fort Worth might benefit from seeing what was done. Sharing and spreading ideas can help prevent each office from having to reinvent the wheel. Or, seeing the ideas implemented by others might inspire our own.

Our view is that a practice with a solid culture of continuous improvement, along with simple methods for facilitating and tracking ideas, would outperform clinics where staff and doctors are told to just show up and do their jobs. As Toyota and Lean healthcare organizations say, “Everybody has two jobs... to do the work and to improve the work.” Kaizen will lead to better client service and outcomes for patients, a better workplace, and better financial results for the practice owner.

Read more in the book Healthcare Kaizen by Mark Graban and Joe Swartz.

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