Once I completed the transformational blog series I realized there is still much more to discuss."Gemba" is an important place and it means "place where value is created". I am going to discuss why going to the Gemba is so important.
In our upcoming book "On the Mend", we describe going to Gemba as on of the core actions of lean leaders. I think Gemba is important for a number of reasons:
1. Leaders learn to see. This means they learn to recognize what steps in a core process are waste. Waste has eight ways of manifesting itself, these are:
The Eight Wastes of Lean Healthcare
1. Defect: making errors, correcting errors, inspecting work already done for error
2. Waiting: for test results to be delivered, for a bed, for an appointment, for release paperwork
3. Motion: searching for supplies, fetching drugs from another room, looking for proper forms
4. Transportation: taking patients through miles of corridors, from one test to the next unnecessarily, transferring patients to new rooms or units, carrying trays of tools between rooms
5. Overproduction: excessive diagnostic testing, unnecessary treatment
6. Over processing: a patient being asked the same question three times, unnecessary forms; nurses writing everything in a chart instead of noting exceptions
7. Inventory (too much or too little): overstocked drugs expiring on the shelf, under stocked surgical supplies delaying procedures while staff goes in search of needed items
8. Talent: failing to listen to employee ideas for improvement, failure to train emergency technicians and doctors in new diagnostic techniques
Once leaders learn to see these wastes they can then help staff to see the waste with the goal to have all staff continuously removing waste.
2. Leaders send a strong message that they really care about the front-line workers' problems. A CEO working with nurses to solve a complex problem has a very positive impact on morale in the hospital or clinic.
3. Leaders understand the business better and know the troubles their staff and patients are experiencing. This knowledge is used to make better decisions on resource priorities.
4. Leaders learn about standard work for management. Gemba is a structured process to review work processes at the front-line. Leaders must come prepared to do that. They should know how to see waste in a patient care process and be able to help staff learn to see that waste. This is done by asking staff questions which helps staff to think about the problems themselves. The leader should never tell the staff what to do but instead need to be able to ask the right questions. This is hard work and requires focus and concentration. This means the leader has to know something about the work and that doesn't happen unless the leader is at the place of work regularly. Good teachers motivate their students to learn more about the subject being studied. Good lean leaders motivate their staff to better understand their work so they can see and remove waste.
Going to Gemba is not an action to be taken lightly. It's hard work and it takes time to learn how to do it effectively. It must be done often to be learned. I invite you to start going to Gemba once a week for four weeks. Each time you go write a log of what you have seen, then compare what you saw the first time to the fourth time. I think you will be surprised you have started to learn to see.
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