Healthcare kaizen : engaging front-line staff in sustainable continuous improvements

Content: WHAT IS KAIZEN?    Kaizen and Continuous Improvement Kaizen = Change for the Better Bubbles for Babies Kaizen: A Powerful Word Kaizen Is Not Just Change, It Is Improvement  We Often Succeed As the Result of Failing More Kaizen, PDSA, and the Scientific Method for Improvement Changing Back Can Be Better For Babies Kaizen = Continuous Improvement Kaizen Starts with Small Changes A Small Kaizen with Great Meaning Kaizen = Engaging Everybody in Their Own Change Kaizen Upon Kaizen Upon Kaizen Kaizen Closes Gaps Between Staff and Leaders Creativity before Capital Expensive Mistakes Made without the Kaizen Mindset Kaizen and Lean: Related and Deeply Interconnected Concepts People Are the Ultimate Competitive Advantage High-Level Kaizen Principles-The Kaizen Mindset      Asking      Empowering      Recognizing      Sharing This Is Not a Suggestion System-It Is an Improvement System Kaizen Has an Impact on People and Performance  The Roots and Evolution of Kaizen Early Suggestion Programs Downsides of Suggestion Box Programs Recovering from Taylorism The American Roots of Continuous Improvement-TWI and Deming Kaizen: One of the Two Pillars of The Toyota Way Masaaki Imai and the Spread of Kaizen (1986) Dr. Donald Berwick's Call for Kaizen (1989) "Medicine's Need for Kaizen" (1990) Norman Bodek and American Kaizen Conclusion Discussion Questions Endnotes        Types of Kaizen The Continuous Improvement of a Lifesaving Innovation Three Levels of Kaizen      Imai's Three Levels of Kaizen      Complementary Nature of the Levels of Kaizen      Three Types of Kaizen at Children's Medical Center Dallas Events Alone Will Not Make You Lean      The Origins of Kaizen Events      Basic Structure and Format of an Improvement Event      Impressive Results from Kaizen in Healthcare           Virginia Mason Medical Center           ThedaCare      Criticisms of Weeklong Events Not All Kaizen Organizations Rely on Events      Kaizen Leads to Innovation at Franciscan  Moving Toward a Kaizen Culture The Real Goal-Cultural Transformation What a Kaizen Culture Feels Like      Everyone Is Engaged           Drivers of Engagement      Everyone Is Relentlessly Searching for Opportunities to Improve      The Two Parents of Transformation: Pain and Possibility           Pain           Possibilities      You Have Control over Your Workplace      Patients and Families Are Happy      Staff and Physicians Are Happy      Work and Patient Care Flow Like Clockwork      The Workspace Is Clean, Orderly, and Safe      Everyone Works Together      Everything Gets Questioned      Small Successes Lead to Bigger Successes Small Kaizen Leads to More Big Ideas      Bite-Size Chunks      Imai's Three Stages of Kaizen     KAIZEN METHODOLOGIES    Quick and Easy Kaizen How to Do Kaizen Quick and Easy Kaizen Starting the Franciscan Kaizen Journey The Quick and Easy Kaizen Process      Step 1-Find           Start Small           Start With You           Make Your Work Easier           Make Your Work Safer           Make Your Work More Interesting           Build Your Skills, Your Capabilities, and Your Knowledge           See an Opportunity or a Problem      Step 2-Discuss           Discuss with your Direct Supervisor           Discuss with Your Team Members           Quantify the Idea      Step 3-Implement           Enrolling Others to Help           Implement the Improvement Idea           Seven Days Grace      Step 4-Document           Finalize the Kaizen report           Submit Report For Approval      Step 5-Share           Leveraging Improvement Ideas from Others           Sharing Kaizens  Visual Idea Boards Making the Improvement Process Visible Setting up a Visual Idea Board      Boards Should Be Highly Visible in the Workplace      Boards in "Public" Settings Communication That Should Occur before the Visual Idea Board Is Put Up      What Happened to the Suggestion Box?      What Employees Can Expect      A Communication Example Formats for Idea Cards      Sticky Notes versus Structured Cards      Idea Cards versus Suggestion Cards      Modeling the Kaizen and PDSA Process in Writing Visual Idea Cards      Problem      Suggestion or Idea      Date Originated      Created By      Expected Benefits      Input Needed From      Implementation Steps      Results Verified?      New Method Standardized?      Completion Date Idea Card Examples      Staff and Patient Annoyances      Asking for Help      Addressing Patient Needs      Getting Input from Others Other Formats of Idea Boards and Cards      Park Nicollet's KEEP Form      Akron Children's Hospital      Seattle Children's Hospital Pharmacy Visual Management of the Idea Boards Using Idea Cards to Coach People on Kaizen      The Suggestion to "Be More Careful"      Something's Not Happening-So Don't Forget      Easier for Us, but Not Best for the Whole System? Tracking Completed Cards  Sharing Kaizen Different Formats for Sharing The Kaizen Wall of Fame Format Kaizen Sharing Examples      Making Things Better for Patients           Supplies for Patients           Improving Meal Rounds      Easier to Get DVDs      Little Details for Patients Preventing Mistakes or Harm      Ensuring Proper Bed Cleaning      Preventing Pressure Ulcers      More Accurate Lab Results Through Standardized Work      Proper X-Ray Ordering      Ensuring Equipment is Ready      Eye Protection for Lab Staff      Preventing Aerosolized Specimens Making Work Easier for Staff      Easier to Plug In Carts      Improved Ergonomics and Specimen Quality      Saving Sore Feet      Better Phone Ergonomics and Productivity      Combining Two Forms Into One Preventing Delays      Faster Code STEMI Heart Attack Care      Meds for Discharged Patients      Getting Patients to Rooms with Less Delay      More Timely Test Results for Rounding      Fewer Supply Chain Delays      Better Access to Endocrinology Saving Space or Cost      Creativity over Capital in the Lab      Company Medical Clinic Costs      An Unnecessary Label      Rethinking Freezer Use  The Art of Kaizen Barriers to Kaizen      Resistance to Change      Lack of Time-We're Too Busy A Model for Mobilizing Support      Tenet 1: Respect Others      Tenet 2: Create a Vision That Matters      Tenet 3: Convey the Why      Tenet 4: Connect to the Mission      Is This About Me or Is This About the Mission? Working with Others Based on Their Willingness to Invest      Strategy 1: Cocreate with Those Eager for Opportunity           Seek Their Ideas           Play Kaizen Catch Ball           Reigniting Everyone's Creativity      Strategy 2: Sell Opportunity to Those That Are Cautious           Encourage           Seven Days Grace           Measure Progress      Strategy 3: Find Common Meaning with and Negotiate with Opposers           Include Opposing Viewpoints           Find Common Meaning           Negotiate           Use Demands as a Last Resort Kaizen and Positive Deviance      Rules for Leaders     KAIZEN LESSONS LEARNED    The Role of Leaders in Kaizen Leading to Create the Culture      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           It Is Not Always about Cost Role of Top-Level Managers      Leadership and Kaizen Participation Starts at the Top           Dr. John Toussaint's Participation           Going to the Gemba      Kaizen Reports Are for Everybody      Key Actions for Top-Level Managers           Key Action 1: Communicate Expectations and Prioritize           Key Action 2: Resource Adequately           Key Action 3: Sponsor a Recognition and Incentives Program           Key Action 4: Share Notable Kaizens           Key Action 5: Thank People Personally Role of Middle-level Managers      Paula's Baby Steps Lead the Way           The "Great Big Pile of Problems"      Leaders Drive Kaizen Success      The Kaizen Difference      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      A First-Level Manager Is a Coach      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        Organization-Wide Kaizen Programs Getting Started      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 Electronic Kaizen Systems      Advantages of an Electronic Online Database           Quick Entry           Automatic Routing and Electronic Approval           Ideas to Hold for Later           Quick Search and Retrieval      Electronic Kaizen within Intermountain Healthcare      Electronic Kaizen at Park Nicollet      Electronic Kaizen at Vanderbilt  Lean Methods for Kaizen Technique 1: Add Value      The Internal Customer's Point of View      Different Forms of Patient Value Technique 2: Eliminate Waste      Waste 1: Transportation      Waste 2: Overproduction      Waste 3: Motion      Waste 4: Defects (Errors and Rework)      Waste 5: Waiting      Waste 6: Inventory      Waste 7: Overprocessing      Waste 8: Lost Human Potential, Creativity, and Opportunities      Seeing Waste Through Process Observation           "Go See"           Spaghetti Diagrams Technique 3: Visual Workplace      Color Coding      Home Locations           Kitchen Example      Borders Technique 4: 5S-Workplace Organization      S1: Sort      S2: Set in Order      S3: Shine      S4: Simplify and Standardize      S5: Sustain Technique 5: Workstation Design Technique 6: Problem Solving      A3 Problem-Solving Technique      Example Problem-Solving A3      Problem-Solving Methods Used with A3           Find the Point of the Cause           Identify the Root Cause Technique 7: Error Proofing      Fatal and Preventable Healthcare Errors      Four Elements of a Zero Defect Quality System           Element 1: Self-Check and Successive Check           Element 2: Immediate Feedback and Corrective Action           Element 3: Source Inspection           Element 4: 100% Inspection    Kaizen At Home Kaizen Tips from an Actress Kaizen Tips from a Behavioral Scientist Kaizen at Home Kaizen before Work      Kaizen for Breakfast      Kaizen to Get Ready for Work      Kaizen with Your Coffee      Kaizen to Get Dressed      Kaizening Cup Clutter      Kaizen on the Way to Work      Kaizen in the Home Office           Kaizen on the Computer           Kaizen on the Physical Desktop      Kaizen after Work      Kaizen for Dinner      Kaizen in the Backyard           Improvements      Kaizen Home Repair      Kaizen for the Earth      Kaizen in the Bathroom      Kaizen and Your Kids      A Vacation from Kaizen?      Kaizen for Repetitive Tasks      Kaizen for the Kaizen Process    Conclusion A Minute to Learn, a Lifetime to Master Your Next Steps Building a Kaizen Community    Each chapter includes a Conclusion, Discussion Questions, and Endnotes