Kaizen = Change for the Better

Excerpt from “Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements” by Mark Graban and Joseph Swartz (Productivity Press, June 2012).

By Mark Graban andJoseph Swartz

The word, “Kaizen,” is translated from Japanese in a number of ways, most simply

as “change for the better.”

Breaking down the word:

  • “Kai” means “change.”
  • “Zen” means “good.”

A “Kaizen” is a small improvement that is made by those who do the work. It is a small, low-cost, low-risk improvement that can be easily implemented. Kaizen is an ongoing methodology and philosophy for challenging and empowering everyone in the organization to use their creative ideas to improve their daily work.

The word, “Kaizen,” the way it typically is used, is synonymous with the phrase, “continuous improvement.” An effective Kaizen approach is about making improvements that are connected to measurable results and a deeper purpose.

Children’s Medical Center (Dallas, TX) has a process improvement campaign that asks the simple question, “Is there a better way?” Clay York, manager of the core laboratory, and other leaders help tie the department’s local improvement efforts to the organization’s mission and purpose by asking team members if proposed changes will help provide “better care for kids.”

Beyond the measurable results, Kaizen organizations value the personal and organizational learning that results from the improvement process, as well as the personal pride and satisfaction of all who are involved. IU Health Goshen Hospital has saved more than $30 million since 1998 with a program called “The Uncommon Leader” as part of its broader improvement program. In 2009, CEO James Dague promised to shave his head if employees generated ideas that saved $3.5 million that year.

The hospital more than doubled that savings goal, so Dague shaved his head in front of his colleagues. The culture at Goshen has shifted to one where every person is empowered to make improvements to his or her daily work, making suggestions that can have an impact on cost, quality, and patient care. For example, an emergency nurse educator saved $4,000 by changing the type of napkins used on patient trays, and the GI department saved $22,000 by switching from disposable paper gowns to cloth gowns. Goshen has gone 17 years without layoffs, undoubtedly a key reason its employees are so enthusiastic about improvement. Goshen also was named one of the top 10 large employer workplaces in Indiana, in part due to its “workplace culture where employees feel valued.”

Many organizations embrace the idea of Kaizen and practice its specific principles, but they call it Continuous Improvement, Process Excellence, or Plan-Do-Study-Act (PDSA) instead of Kaizen. That is perfectly fine; what we call it does not matter as much as the patient benefits, staff engagement, and organizational improvements that we achieve with these practices.

Kaizen Is Not Just Change, It Is Improvement

With Kaizen, we want more than a lot of activity and change; we really want improvement and learning. Improvement comes when we can state that things have been made better in one or more dimensions, including safety, quality, productivity, or having a less frustrating workplace. Not all changes are necessarily improvements. For example, a change to a process that makes it harder for nurses to gather the supplies needed to start an IV likely would not be considered an improvement, because it would delay patient care and cause more work for the nurses.

Kaizen involves finding a better way to do your work and changing the method you use to do your work. Kaizen is not about cutting corners. If you cut a step out of your work, you will want to talk to your coworkers to ensure that cutting out that step does not negatively affect the patient or someone else in the process. For example, it would not be a Kaizen if a nurse decided to save time by checking only one patient identifier instead of two when giving a medication, because this would increase the risk of errors and harm to the patient.

A planned improvement should be proposed as a hypothesis to be tested in practice. For example, a materials management team might propose, “If we rearrange the clean utility room to stock items in the order of their computerized order number, then it reduces the amount of time required to restock rooms each day.” After testing that change for three days, the materials management team might conclude that they, indeed, saved 30 minutes per day, in addition to the hours spent rearranging the first utility room in which they tested their change. As their test confirmed their expectations, the materials team might decide to share this change with other units.

Large, complex organizations, such as those in health care, need to be aware that one area’s improvement may cause side effects in other areas. For example, if the change benefited materials management but made work more difficult for the nurses who take items (often urgently needed) from the supply rooms, then, when looking at the big picture, the change might not be an improvement after all.

Continuous Improvement

Again, one common translation of Kaizen generally is “change for the better.” These changes can include team projects, such as “Kaizen Events” or “Rapid Improvement Events” (RIEs).

In this book, we will use the term, “Kaizen.” in the context that is often least practiced and least appreciated in health care (as well as other industries)—continuous improvements that happen without the formal structure of a large team or a major project.

High-Level Kaizen Principles—The Kaizen Mindset

Kaizen uses a defined set of principles that guides the problem-solving and improvement processes. Kaizen requires more than just putting a group together in a room and telling them they have time to make improvements. Ideally, leaders at all levels should be able to coach and guide employees and lower-level managers about these principles and mindsets to ensure the most effective and most sustainable improvements. The best way for leaders to learn how to coach others on Kaizen is to practice it in their own work.

Pascal Dennis, author and former Toyota manager in Canada, defines “Kaizen spirit” as:

  1. Cheerfulness: The conviction that things will be better tomorrow, no matter how tough they are today.
  2. Go See: The desire to get out of the office and experience things first-hand; the willingness of leaders to work with front-line staff with humility and openness.
  3. Get Your Hands Dirty: We roll up our sleeves and try improvements with our colleagues.

Kaizen is not a series of tricks, tips, or techniques that can be copied easily; it is primarily about a culture and a way of thinking. Kaizen is not a matter of chasing external targets and performance benchmarks; it is about your employees’ internal drive to come up with their own improvements that allow them to be the best they can be.

At a high level, Kaizen is about:

  • Asking all employees to search for and identify improvement opportunities.
  • Empowering all employees to implement small improvements to their daily work.
  • Recognizing employees for those improvements.
  • Sharing and spreading improvement ideas throughout the organization, along with lessons learned.d Shipping

Excerpt from “Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements” by Mark Graban and Joseph Swartz (Productivity Press, June 2012). For more information, visit www.hckaizen.com.

Joseph E. Swartz is the director of Business Transformation for Franciscan St. Francis Health of Indianapolis, IN. He has been leading continuous improvement efforts for 18 years, including seven years in health care, and has led more than 200 Lean and Six Sigma improvement projects. Swartz is the co-author of “Seeing David in the Stone” and was previously an instructor at the University of Wisconsin. He earned an MS degree in Management from Purdue University as a Krannert Scholar for academic excellence.

Mark Graban is the author of the Shingo Award-winning book, “Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement” and co-author of “Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements.” He is also the founder of LeanBlog.org and chief improvement officer of KaiNexus, a software startup. With a background in engineering and manufacturing, Graban has worked exclusively in health care since 2005 where he applies Lean and Toyota Production System principles to improve quality of care and patient safety, to improve the customer/patient experience, to help the development of medical professionals and employees, and to help build strong organizations for the long term. For more information, visit www.MarkGraban.com.

Lorri Freifeld
Lorri Freifeld is the editor/publisher of Training magazine. She writes on a number of topics, including talent management, training technology, and leadership development. She spearheads two awards programs: the Training APEX Awards and Emerging Training Leaders. A writer/editor for the last 30 years, she has held editing positions at a variety of publications and holds a Master’s degree in journalism from New York University.