Kaizen: The Key To Lean Healthcare?


Ken Congdon at Healthcare Technology Online  recently interviewed me for this story that's now online:  Kaizen: The Key To Lean Healthcare?.

Mark Graban, lean expert and co-author of an upcoming book titled  Healthcare Kaizen, often compares Kaizen to the suggestion box methodology. “Traditionally, suggestion boxes have employees submit anonymous ideas,” says Graban. “Those ideas are then reviewed by a committee on a monthly or quarterly basis and are either  or dismissed. The individual who submitted the idea rarely gets any feedback on their idea. Kaizen, on the other hand, is a local process that moves much faster than the suggestion box approach. Someone in a work group will talk to their supervisor about a change they feel should be implemented. These ideas are either collected on a bulletin board or entered into a web-tracking system. Rather than running these ideas up to a committee, the employee that made the suggestion and their supervisor are empowered to implement these changes on their own.   The idea of Kaizen is that a lot of little ideas evaluated and implemented at a local level can have a huge impact on an organization and can generally be implemented much more quickly and easily than a single million-dollar idea handed down from corporate.”

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I really like the idea of kaizen and the speed with which it can allow improvements to be implemented and enable employee empowerment. What challenges are you seeing in healthcare to that approach? Kaizen is almost a disruptive methodology, and I think this is where the need for major culture change becomes apparent.

    • Hi KeAnne — we cover this on our book, some of the frequently stated barriers to Kaizen.

      There are two major ones:

      1) “We don’t have time” — a more accurate statement might be “we aren’t making time.”

      2) Managers or leaders have been conditioned to think they are the only ones who can come up with improvement ideas, not the staff.

      Kaizen isn’t complicated, but it sometimes requires an attitude adjustment… and the willingness to put in the effort to make it happen.

  2. Mark,

    As you may know we are working on daily kaizen in our PICU at East Tennessee Children’s Hospital. We are trying to get away from just a project based program where the “lean guy” or management is still solving all of the problems. We’ve had success with physicians, nurse practitioner, educators, nurse managers and other formal leaders conducting problem solving but have still not “cracked the nut” on frontline staff being involved with problem solving and daily improvements. We are however getting great ideas from frontline staff on ideas for problems to solve. All that said here are my questions that come from your statement, “the employee that made the suggestion and their supervisor are empowered to implement these changes on their own”.

    1)Are you suggesting that frontline employees always work with their supervisor to solve these problems?
    2)Is it too much to ask of frontline employees to do it completely on their own during the course of work?
    3)How can a hospital from a management side create the environment and time for staff to problem solve? We have thought of setting an expectation and providing 4 hours (or any set period of time) a month for staff to spend on problem solving and call it the “4 Hour Challenge”. Instead of staff going home or floating to another department when census is low, they use that time for problem solving.
    4)What role does upper management (CEO’s, VP’s & Directors) have in promoting daily kaizen or should if primarily be middle management (Unit/Department Managers and Assistant Mangers)?

    • Isaac – thanks for sharing what you and your organization are working on. Great questions.

      1) Not “always.” If things can be addressed locally, then we want the employee and supervisor to work on the PDSA cycle (drawing in team members, as appropriate). Kaizen is never a solo activity. There are some problems that need to be escalated to higher levels in the organization or other departments. Leaders balance “empowerment” with “servant leadership” as required. Early in a “quick and easy kaizen” program, we want people to focus on things they can improve rather than only lobbing suggestions upward.

      2) Again, we’re not asking them to do it “completely on their own.” Leaders need to help create time and support and coach people. This is a collaborative improvement process, we’re not just dumping work on people.

      3) YES! Instead of sending people home, do Kaizen. When people say “we don’t have time,” we have to figure out how to make time.

      4) This is chapter 9 of our book, and leadership is discussed throughout. All levels of leaders can encourage kaizen, practice it in their own work, coach it, and recognize it. The CEO can recognize people for doing kaizen in ways that are different than front-line leaders, of course.

      Your questions might be good additions to the “FAQ” page on our website… so thanks.



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