During a recent visit to Franciscan St. Francis Health, several nurses proudly introduced themselves as “Kaizen Queens”–and one, with a smile, as the “Kaizen Princess.” Across the hospital, the broader term “Kaizeneer” is used to describe anyone who takes part in continuous improvement, but this team had clearly made the idea their own.
In the endoscopy department, they have implemented more than 750 improvements over the past four years (with a team of 30 people). That sets the bar really high for the rest of the Franciscan system and for healthcare organizations everywhere.
One of the Kaizen Queens wore a badge holder that proudly proclaimed that she had implemented more than 200 Kaizens. This means she either initiated the process or was part of a team–they share credit, recognition, and rewards quite freely.
One of her colleagues described a Kaizen improvement in which the first step was to identify a problem: patients who needed a scope down their throat for a particular test were asked to swallow a thick, viscous lubricant purchased from the scope manufacturer. T
he patients hated the goop–the taste and texture (as if having a scope down your throat wasn't bad enough). She said it was like, sorry,
“flavored snot.”
The nurse had an idea one day: would applesauce work as a substitute for the lubricant? The five-step process we use (and describe in our books) does not include rushing to test an idea.
That makes me think of Peter Brady and The Brady Bunch. “Pork Chops and Applesauce…”
The five steps of the Kaizen process at Franciscan are:
- Find ideas
- Discuss them
- Implement (test) them
- Document them
- Share them
So what happened here?
The nurse saw an opportunity. They talked with her colleagues and the manager. She reached out to the scope maker to see if applesauce would cause any problems. Everybody gave a thumbs up to trying the applesauce.
A common theme across the departments we visited was that managers rarely say no to ideas. Saying no discourages people. Possible improvements are proven out (or disproven) through testing and practice (following the PDSA cycle of Plan, Do, Study, Adjust). Managers do occasionally say “no” if an idea would violate regulations or other guidelines. But they then work together to find a different idea that would solve their problem.
In this case, the use of applesauce was indeed an improvement. Like most Kaizens, it was a win/win/win/win – using applesauce saves the hospital $30,000 a year, it's preferred by the patients, it creates a less frustrating environment for the staff, and it doesn't negatively impact the quality of the scope testing.
The Kaizeneers documented and shared the idea. Imagine if that idea could be shared more broadly throughout our nation's healthcare system (or beyond). We don't have many mechanisms out there for sharing ideas. We do have forums like the Healthcare Value Network or AHRQ, or technologies like KaiNexus (which allows users to selectively publish ideas to be seen by users at other organizations).
Hear their story directly from the source:
By the way, if you have a Kaizen you'd like to share with others, you can do that through our book's website.
In many hospitals, there would have been a laundry list of reasons for a manager to say no to the idea.
- “Just use the standard lubricant.”
- “Oh, patients don't hate it that much.”
- “Why can't you just follow the standard work?”
- “We'll have our quality committee discuss that.”
Leaders who say things like that stifle improvement and innovation and damage morale.
I asked one of the endoscopy nurses what would happen if she, for some reason, ended up in a workplace without a manager who encouraged and supported Kaizen. She said she would probably try to push Kaizen and bring ideas forward for a while (thanks to her intrinsic motivation). But if the manager wasn't into it, she'd probably just stop trying.
There are so many more stories from that day–each one a reminder that real improvement doesn't come from mandates or memos, but from people who care enough to solve problems and leaders who care enough to let them.
When leaders say “yes” to ideas–or at least “let's test it”– they're not just approving a suggestion. They're reinforcing trust, autonomy, and psychological safety. The result? A system that learns, one small improvement at a time.
As we share stories like the applesauce Kaizen, I hope more organizations recognize that progress often starts with something humble–a conversation, a question, a spoonful of curiosity.
Stay tuned for more from Franciscan and other “Kaizeneers” who remind us what's possible when people are respected, supported, and empowered to make care better for everyone.
If you’re working to build a culture where people feel safe to speak up, solve problems, and improve every day, I’d be glad to help. Let’s talk about how to strengthen Psychological Safety and Continuous Improvement in your organization.
