Video: Salem Health CEO & Senior Leaders Comments About Visiting Japan

As described on the YouTube page for this video, a group of Salem Hospital (Oregon) staff members (senior leaders, front-line staff, clinicians) visited Japan in 2011 to study Lean and Kaizen (continuous improvement): “Salem Hospital leaders reflect on strategic trip to Japan.”

As the CEO Norm Gruber says at the beginning was “an experiment” but they concluded afterward it was “clearly it was worth going.” During the trip, “[job] titles disappeared completely,” says Gruber. COO Cheryl Nester Wolfe commented, “a patient is not a car – absolutely not – but the work that people do to make that product (or that patient) better are very similar. Ours is about how do we take exceptional care of our patients every single time.”

The video:

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Some other things that stood out to me:

The discussion about the role that Japanese culture plays – are the Japanese people more collaborative?  Toyota has done well in the U.S. with their Kaizen approach and I’ve seen data that suggests the U.S. plants often outperform the Japanese plants in their Kaizen activity. It maybe “comes more naturally,” in Japan, says Gruber, but I’d point out that it’s definitely possible here – including in healthcare.

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The COO said that the focus on “respect for people” became her “most clarifying moment” especially related to the role of leaders in engaging people to come forward with and implement their ideas (a core theme in my upcoming book Healthcare Kaizen).

Senior leaders are going to start rounding (or what we’d usually call a “gemba walk” in the Lean framework) to help managers get to the CEO on the front-line to help understand problems and to work together on improvements.  Nester Wolfe points out that Lean and Kaizen are not the quick fix that so many are usually looking for in healthcare.

I don’t it’s absolutely necessary to go to Japan, but it sounds like Salem Health got a lot out of the trip. Their lessons learned will benefit their patients, their staff and physicians, and the long-term health of Salem Health, the organization.


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an book titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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