Last Wednesday and Thursday, I collaborated with Joe Swartz and a countless number of his colleagues to host 24 visitors from different health systems (and an Indiana state government organization) to learn about the “Kaizen” approach to continuous improvement first hand at Joe's health system – Franciscan St. Francis Health in Indianapolis.
I tend to “take notes” these days via Twitter and you can read all of my tweets and quotes if you like. Here are a few highlights, incorporating some of these tweets, as appropriate.
Welcome and Greetings
As in the Franciscan tradition, the meeting was started with an invocation from Sister Martha Ann, one of the five nuns who still help run the hospital (and she's a certified Lean Sigma Green Belt).
Appropriately, for the type of improvement work we all do, she invoked the “Serenity Prayer” in her remarks:
O God, give us the serenity to accept what cannot be changed,
The courage to change what can be changed,
and the wisdom to know the one from the other
CEO Bob Brody
We also had opening remarks from their CEO, Bob Brody:
CEO Bob Brody welcoming the group to #KaizenLive. It started with #Deming. pic.twitter.com/kZror3RHdH
— Mark Graban (@MarkGraban) April 22, 2015
Yes, the memory and principles of W. Edwards Deming are alive and well. Brody said,
“The first thing to do is drive out fear. It's not people, it's processes that fail.”
He added:
“We're constantly looking for ways to improve our own performance. Improve value & services for our patients. It adds up.”
Perhaps thinking back to Deming's “survival is optional quote,” Brody said:
“Continual improvement is absolutely necessary if we're going to survive.”
CNO Susan McRoberts
Their CNO, Susan McRoberts, gave a longer talk about their Kaizen approach and their journey toward being a culture of continuous improvement.
She said:
“There have been a lot of fads, but Lean Six Sigma is not one of them. It works.”
Why do they do Kaizen?
- Because it saves time
- It's data driven
- It makes life easier
- Because it's short and sweet
- It can be, for the most part, generalized
- Because it changes the culture
This was a key point for the attendees… the idea that the PRACTICE of Kaizen leads to a culture of continuous improvement. One attendee commented that she had, basically, gotten stuck in a trap where they felt like they couldn't try Kaizen because they didn't have the right culture in place. Nobody ever has that culture in place when they start and the attendees learned a powerful lesson (or were reminded of that).
See my past blog post about how the best time to start is today.
Some other comments from McRoberts:
Sometimes people have to break the rules to innovate, but you need to balance being careful because lives are at stake #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
That's an important point… it has to be OK for people to “make mistakes” but that doesn't give us a blank check to act recklessly. Find the right balance…
Healthcare people are good at making things work for the patient – workarounds. #Kaizen shouldn't be a workaround. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
We have to help staff realize when they are just working around a bad process instead of fixing the cause of the problem.
Listen to Mark read the post (learn more):
You have to help create an environment where people can speak up:
Don't accept things that aren't working for you or the patient. Report problems. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
And leaders need to be helpful, not “the boss.”
Easy for senior leaders to forget that front line staff are the experts. Change from being "a suit" to be a coach & resource. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
And, if individuals struggle with Kaizen, that's the responsibility of the leader to help fix that instead of blaming them as being bad people.
If people can't do Kaizen, that's on me as a leader because my job is to develop them. – CNO #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
As a nurse, McRoberts realize that it's all about the patient and the need to improve their care:
CNO – kaizen can't be all about money though. Focus on the patient experience. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
But they do try to add up cost savings when they see it (and they have finance validate large savings):
CNO – some kaizens result in enormous cost savings AND better patient experience #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
She finished her comments with praise for Joe Swartz (who is incredibly humble).
CNO – "employee engagement is everything." And @JoeKaizeneer is a humble role model who lives our values. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
Kaizen fits with the hospital's values and, in particular, the Franciscan Values.
The Current State of Kaizen
Before we went on the first of our gemba visits, Joe talked about the current state of Kaizen at Franciscan and what their current challenges are.
They measure the percentage of employees who formally participate in the “quick and easy kaizen” program. Last year it was 38%. Their goal this year is 50% participation and their long-term goal is to have everybody participate.
In the early days of their Lean Sigma approach, they didn't have a robust approach to continuous improvement.
Joe learned that #lean wasn't very powerful without #kaizen #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
You have to help people see the benefits of Kaizen – what's in it for them and their patients?
You can't just hope for change. Show people tangible benefits of before / after comparisons. Let people take action. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
When you show real examples of Kaizen improvements (especially small stuff), people say “Oh, I can do that!” and they participate.
That was a key lesson for one attendee, who is going to go back and do a better job of showing people examples of the types of Kaizen improvements they are looking for to get started (little stuff, not million-dollar ideas).
Every kaizen we share broadly is a message to staff. Start small, low cost. Make work easier & more enjoyable. #KaizenLive @JoeKaizeneer
— Mark Graban (@MarkGraban) April 22, 2015
Joe dropped a lot of wisdom on the group, including:
People are more eager to learn after they have tried. If "stub their toe" in the process give them coaching & help #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
I like to emphasize that everybody struggles with Kaizen at first. That's OK. That's to be expected.
We're teaching all of our employees to be change agents. Keep it simple. People get better at this over time. Make it simpler. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
But you need coaching and support, rather than being left to flounder. You need to find ways to make them WANT to participate in Kaizen.
Joe's team has shifted from leading projects to more coaching and mentoring others #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
Don't change people. Get them to participate in kaizen so they change themselves says @JoeKaizeneer #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
"Don't try to change the culture. Practicing #kaizen, changing what people do, changes the culture." #KaizenLive @JoeKaizeneer
— Mark Graban (@MarkGraban) April 22, 2015
"People better absorb large change when they participate in small change everyday" says @JoeKaizeneer #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
If kaizen is too much of a time burden on managers, they are probably trying to take it all on instead & delegate & coach #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
This was a lesson repeated by all managers — the role of managers is not to collect suggestions and do all of the work themselves!
Emergency Department Improvements
Joe talked about improving the emergency department by breaking a big problem up into smaller Kaizens.
Large scale ER transformation was sequential #Kaizen, lots of PDSA. Make changes that helped staff & patients. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
ER patient sat went from 13th %tile to 65th & they are still improving @StFrancisHealth #KaizenLive door to MD time cut in half
— Mark Graban (@MarkGraban) April 22, 2015
And they improved inpatient satisfaction:
Increase in inpatient satisfaction from 38th to 74th %-tile, break the big problem down into smaller #kaizen chunks #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
The Spread of Kaizen
They have successfully used Kaizen in their three Indianapolis hospitals. But, the larger “Franciscan Alliance” organization has hospitals in other parts of Indiana and the Chicago area.
They've tried to spread these practices, but:
Joe's Lesson from trying to spread #kaizen – it fizzled without a dedicated resource to champion, coach, track the efforts. #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
Joe & the parent health system will try again to spread #kaizen from 3 hospitals to all of them, learning from past attempt #KaizenLive
— Mark Graban (@MarkGraban) April 22, 2015
Coming Soon
In future blog posts, I'll share thoughts about the gemba visits to the NICU (where I helped host) and thoughts from the discussions and sessions led by different department directors.
If you'd like to sign up to be notified about a possible workshop, please contact us. Or, read more about the workshops.
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[…] my first post about the on-site Kaizen learning experience at Franciscan St. Francis Health, an event I came to call “Kaizen Live,” I wrote about some of the initial presentations […]