This is the 6th blog in my series on organizational transformation. We have organized these blogs into three categories based on the important components of Purpose, Process, and People. We are still exploring the category of process and this week are focused on kaizen.
Kaizen is from the Japanese symbols meaning “change” and “good.” It is usually translated as “change for the better.” Kaizen takes many forms from simple projects to week long improvement events. At ThedaCare we have used Rapid Improvement Events(RIES) as the way to improve complicated processes and to build effective teams. The action of an RIE is focused on a single week in which a cross-functional team studies a problem and makes immediate changes to the process. The full event is actually a seven-week cycle. Prior to the team week, a manager in the targeted area and the project sponsor establish quality, productivity and throughput goals, pick a team, collect existing data and/or conduct new time studies. Teams usually have a dozen or so members, drawn from front-line staff such as doctors, nurses and clerks, plus support staff such as pharmacists, radiology and EMS technicians, and then others who work nearby, or in upstream or downstream procedures, plus an outsider. The outsider might be from a different department or hospital, or from another company. Teams also try to include patients whenever possible, to ensure everyone stays patient focused. Day one of the RIE week includes a brief orientation period, with training in lean principles and details of the project at hand. The team then goes to the department or clinic area, maps the existing state and conducts time studies as staff members work through their usual routines. Day two, the team develops maps and timelines describing the current and ideal states. From this, members design the future state – taking into account practical realities while improving the process. The goal is always to pursue the ideal state, while improving what can be improved immediately. If machinery needs to be moved or roles need to change, team members often spend part of the day hauling equipment and briefing staff in the area. The difficulty of coming to consensus and then making real changes in areas where habits may be deeply entrenched has led staff to dub this Prozac Tuesday. By day three, the team watches and assists as staff in the target area runs and tests the new process. By day four, team members write and implement new standard work for the process. Day five, the team reports on early results during a company-wide Friday morning report-out meeting that includes up to six presenting teams and more than a hundred people in a local junior college auditorium. The report-out is part teaching session, part evangelical lean revival. As senior leaders, we make it a point to attend as often as possible. Kaizen is one of the core components to the improvement methodology and without it it is very difficult to make substantial change. Efforts to improve with 6 month improvement activity have met with little sustainability. We experimented with something called 90 day workouts which, frankly, by 90 days most people had already moved on to another issue which resulted no organizational benefit. The key learning with kaizen is that it needs to be rapid. Rapid experiments with focused energy deliver better results because it allows teams to experiment with more than one countermeasure, PDSA that countermeasure, and improve it until an effective solution emerges. If this isn’t done rapidly(in the kaizen week) ideas and experiments lose momentum and change doesn’t happen. Having said all this, however, Kaizen doesn’t stand on it’s own. Without standard work and rigorous audit and management of the standard work most improvements revert back to the original state. In my next blog I plan to discuss the role of standard work and auditing standard work as a key component of the methodology of continuous improvement.
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