What Little Thing Made This Nurse Manager Realize She DID Have A Lot Of Ideas?


Today's post is just something pointing I wrote another article for the LinkedIn “Influencer” series (see my past posts here).

The new article is titled: “The Little Difference That Turned “No Ideas” Into “Lots of Ideas.”

You can also read it on Medium.com or scroll down.

I hope you'll check it out and feel free to comment there (which is a broader business audience that might not know what Kaizen or Lean are) or you can comment here, of course.

Thanks for checking it out.

“I can't think of any improvement ideas,” said a nurse manager as she sighed and walked toward the auditorium to hear me lead a workshop about an approach to continuous improvement called “Kaizen.”

(Read More: Kaizen: Creating a Culture of Continuous Improvement)

After the workshop, I had the chance to meet that manager as we prepared to work together for the next two days in her inpatient surgical care unit. She exclaimed, “Look at my notepad! I didn't think I had any ideas. But as you were talking, I must have scribbled ten ideas down here, things we can quickly improve!”

What made the difference? The manager told me, “I thought we were supposed to come up with ideas for reducing costs. I couldn't think of any. But, when you explained that Kaizen was about saving time, making our work easier, and improving patient care, I realized I had a lot of ideas after all!”

In my experience, healthcare professionals generally don't get excited about the department's budget or the hospital's bottom line. They just don't think about those things very much. They're thinking about their patients and they're annoyed by problems and waste that get in the way of providing the best care to them.

Since this hospital is a customer of KaiNexus, we logged into the system to record problems or “opportunities for improvement” and her initial ideas about how to fix things. She pointed out problems and opportunities like:

  • People are always running into that drawer in the nurses station that doesn't stay closed (fixing this would reduce a small workplace frustration)
  • Coming up with a process for wiping down shared staff phones to reduce the possible spread of germs (helping prevent staff and patients from getting sick)
  • Nurses and techs could see that a patient had eaten half of their meal, but it was hard to remember how many ounces of food that might be. Her idea was to create and post a simple reference sheet to make it easier to accurately record this in the patient record.

These were problems and solutions that mattered to her and her team. They saw these problems and, when asked, could point them out and come up with great ideas. Each of these ideas, and the 12 others that were identified by others in the department over the next two days, would each make a small difference. It was difficult to identify a direct cost savings for each idea. But, a key Kaizen principle is to encourage participation, emphasizing that every idea, no matter how small, is a good idea and is something worth implementing.

The Kaizen approach engages nurses and staff about things they're excited to work on. As this video shows, from my Healthcare Kaizen co-author's health system (Franciscan St. Francis Health), hospital employees are happy to help save money. Compared to times when we make cost cutting the primary goal, we actually end up saving more money when dollars and cents are an end result of improving patient care or making the workplace less frustrating.

The nurses say, in part:

“None of us look at it as, ‘OK, how are we trying to save money or increase throughput?'… That is what we're doing, but that's not how we think of it. We think of it, how are we helping a patient be more satisfied? How are we making this a safer place for everyone? That's where we think about. I think if we have that focus from our management team that said, “You know, you have to save money,” I think it would be different. It would have a different feel to it.”

(See more videos from Franciscan St. Francis)

If leaders say “no” to small ideas because they don't think it's really a problem or because there isn't an ROI (return on investment) to calculate, people might stop bringing their ideas forward altogether. The loss from that lack of participation can be immeasurable.

In the data I've seen from many health systems, about one in ten ideas generated in a Kaizen program has some sort of measurable direct cost savings. The result might be $500 in annual supply savings or 10 hours of overtime reduced each week. The other nine ideas out of ten improve safety, quality, the patient experience, or employee satisfaction. Implementing a large number of small ideas might lead to lower staff turnover rates, which can save a lot of money, by the way.

Roughly one out of every 250 or 300 ideas ends up having a surprisingly large direct financial impact. One of our KaiNexus customers made a small improvement to educate patients in an endocrinology unit about how it might be easier and more convenient for them to get their prescriptions filled inside the hospital instead of going to an outside pharmacy. The nurse who submitted this idea was thinking about the patient experience and better clinical integration. In the first three months, the hospital generated an additional $600,000 in pharmacy reimbursements when about one third of the patients started using their pharmacy.

Small ideas can add up to have a large impact. Sometimes, small ideas have a bigger impact than we could have realized. That's why the sheer number of improvement ideas matters (about 25,000 implemented at Franciscan St. Francis since 2007). That's why they built an online database years ago to track and share all of these improvements (and that's a problem KaiNexus solves, as well).

Hospitals normally ask for cost savings and they encourage people to come up with big projects and big ideas. In a Kaizen approach, we're asking people to save time and make things better in other ways. Franciscan St. Francis has saved millions of dollars using this approach. Our KaiNexus customers have generated more than $44 million in financial benefits from improvement and innovation efforts. And you can too… what can you do in 2015 to help create a culture of continuous improvement in hospitals or any workplace?

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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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. Good article, Mark. Improvement can’t always be measured in dollars and cents, and placing it into a different context is a great way to spur new ideas.


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