Suggestion boxes, while well intended, usually fail to engage workforces in meaningful improvement. The "kaizen" model (from Lean and Toyota Production System), however, is alive and thriving in many organizations. This webinar will focus on key differences between suggestion box programs and the kaizen model, giving specific tips and ideas that your organization can adopt. bout the Presenter Mark Graban is a popular speaker at conferences and private healthcare meetings. He has guest lectured at schools including MIT and Wharton and has served as a faculty member for the Institute for Healthcare Improvement. He has been quoted and interviewed in many publications, including Health Affairs and the New York Times.

1. The
Sugges)on
Box
is
Dead…
But
Staff
Improvement
Ideas
Live
On
Mark
Graban
President,
Constancy,
Inc.
Chief
Improvement
Officer,
KaiNexus
Faculty,
Lean
Enterprise
Ins)tute
August
23,
2012
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

2. ©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

3. ©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

4. Dysfunc)ons
of
Sugges)on
Systems
• Slow
/
No
Response
• Yes
/
No
Answers
• Not
CollaboraDve
• Not
Transparent
• Buy
Instead
of
Do?
• Complaints
Against
Others
• IncenDves
à
FighDng
• Quotas
à
Gaming
Builds
on
the
book
Ideas
are
Free!
by
Robinson
&
Schroeder
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

5. Kaizen
=
Change
for
the
BeTer
• ‘Kai’
means
“change.”
• ‘zen’
means
“good.”
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

6. Kaizen is Not Just Events
Very few
Large issues System
Kaizen
Six
Sigma
Few Project
Medium issues
Lean
Event
Many
Small issues
Daily Kaizen
Adapted from: “The Toyota” Way Fieldbook, Liker and Meier
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

7.
“What
Sets
Us
Apart?”
“Every
Toyota
team
member
is
empowered
with
the
ability
to
improve
their
work
environment.
This
includes
everything
from
quality
and
safety
to
the
environment
and
produc)vity.
Improvements
and
sugges)ons
by
team
members
are
the
cornerstone
of
Toyota's
success.”
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

8. Kaizen
is
for
Everyone!
“…
emphasizes
morale-­‐
boos)ng
benefits
and
posi)ve
employee
par)cipa)on
over
the
economic
and
financial
incen)ves…”
-­‐
Masaaki
Imai
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

9. Dr.
Berwick’s
Call
for
Kaizen
(1989)
• Kaizen
=
“the
conDnuous
search
for
opportuniDes
for
all
processes
to
get
beYer”
• Dr.
Donald
Berwick
– Founder,
InsDtute
for
Healthcare
Improvement
– Former
Administrator,
Medicare
and
Medicaid
(CMS)
CitaDon:
Berwick,
DM,
“ConDnuous
improvement
as
an
ideal
in
health
care,”
New
England
Journal
of
Medicine,
1989
May
25;320(21):1424-­‐5.
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

10. Barriers
to
Kaizen?
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

11. Fear
of
Layoffs
Found
posted
in
a
hospital
lab
(during
ini9al
Lean
assessment)
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source
unknown

12. “No
Layoffs
Due
to
Lean”
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

13. We
Don’t
Have
Time?
“Mikki
Gremp,
RN,
lef
one
hospital
because
a
number
of
policies,
including
its
pracDce
of
'flexing
down,'
lef
her
feeling
that
nurses
weren't
valued.”
AJN Report: The Other Side of Mandatory Overtime
Roxanne Nelson BSN, RN
Maureen Shawn Kennedy MA, RN, editorial director
AJN, American Journal of Nursing
April 2008, Volume 108 Number 4, Pages 23 - 24
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

14. People
Hate
Change?
“People
don’t
resist
change,
they
resist
being
changed.”
– Peter
Scholtes
(1938-­‐2009)
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

15. Why
Not
Best
Prac)ces?
“People
support
what
they
create.”
-­‐
Margaret
J.
Wheatley
See
YouTube:
hYp://bit.ly/Support-­‐Create
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

16. Joint
Commission
Now
Says…
“it
may
be
Dme
for
hospitals
to
move
away
from
best
prac)ces
and
develop
comprehensive
process
improvement
tools
—
which
can
include
Lean,
Six
Sigma
or
other
emerging
methodologies
—
that
allow
for
deeper,
more
specific
analyses
of
their
pa)ent
safety
needs.”
-­‐
Mark
Chassin,
MD,
President
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

17. A
Proposed
Formula
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

18. Completed
Kaizen
Example
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

19. “Quick
and
Easy”
Kaizen
Find
1. Find
2. Discuss
Discuss
3. Implement
Implement
4. Document
5. Share
Document
Share
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

20. Why
Kaizen?
Norman Bodek
1. Make your work easier
2. Make your work more
interesting
3. Develop your skills &
capabilities
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

21. Start
Small
• “There
are
no
big
problems,
there
are
just
a
lot
of
liYle
problems.”
– Henry
Ford
• Make
your
job
easier
• Save
a
few
seconds
• Improve
paDent
care
or
service
• Improve
safety
• Reduce
waiDng
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

22. Itera)ve
PDSA
Improvements
Improvements
Ideas
One
improvement
ofen
leads
to
another
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

23. Improvements
for
NICU
Moms
(1)
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

24. Improvements
for
NICU
Moms
(2)
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

25. Improvements
for
NICU
Moms
(3)
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

26. Kaizen:
Real,
Daily,
Visual
(Visual
Idea
Board)
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Children’s
Medical
Center
Dallas
(Lab)

27. Kaizen:
Real,
Daily,
Visual
(Electronic
-­‐
KaiNexus)
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

28. Completed
“Idea
Card”
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

29. Kaizen
on
Her
FIRST
Day
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

30. Kaizen
“Wall
of
Fame”
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Children’s
Medical
Center
Dallas
(Lab)

31. Innova)on
&
Kaizen
EHART
Blood
Pressure
Cuffs
Before After
Taking time digging through the bucket on top Place a small strip of Velcro® brand hook and loop fasteners on the
of the crash cart to try to find the correct size wall with different sizes of BP cuffs. Staff is able to quickly visualize
blood pressure cuffs. This can be problematic the different sized cuff and get the proper size for the patient, and the
during an EHART® when you want to get a blood pressure can be obtained quicker.
blood pressure (BP) in a hurry so that you can
get medications in the patients.
The Effect
Improved quality of care and faster response to the needs of the patient in an acute setting.
Name Supervisor Date Savings
Elizabeth Black Diana Brown, Manager 12-10-2008 Quality
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

32. “Just
Do
Its”
&
Problem
Solving
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

33. Problems
&
Opportuni)es
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

34. What
Can
We
Do
as
Leaders?
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

35. ©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

36. ©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

37. What
Can
We
Do
as
Leaders?
• Ask
for
Kaizen
– Help
create
Dme
– Don’t
stop
asking
• Lead
by
example
–
parDcipate
– Get
involved
–
coach,
mentor,
lead
– Go
to
the
gemba
– Teach
root
cause
problem
solving
– Follow
the
PDSA
process
• Recognize
and
celebrate
Kaizen
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

38. Asking
Every
Day
• Are
there
any
problems
interfering
with
your
work?
• With
paDent
care?
• Have
you
had
any
ideas
for
improvement
lately?
• Do
you
have
what
you
need
to
do
your
job?
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

39. Coaching
on
Idea
Cards
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

40. Before
/
Amer
Data
from
CMC
Lab
Before Lean 12 Months
After Starting
Lean
3. I have the opportunity to do what I do
best every day.
3.11 3.92
8. I feel free to make suggestions for
improvement.
2.84 3.48
10. I feel secure in my job.
2.32 3.42
13. Stress at work is manageable.
2.43 3.23
17. I am satisfied with the lab as a place
to work.
2.51 3.43
18. I would recommend my work area as
a good place to work to others.
2.38 3.46
Grand Average
2.96 3.69
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

41. KaiNexus
Data
/
Charts
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Whitepaper:
hYp://bit.ly/KaiNexus

42. Franciscan
Par)cipa)on
%
People
Par)cipa)ng
60%
50%
40%
30%
56%
46%
20%
10%
0%
2011
Since
2007
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

43. #
of
Recorded
Kaizens
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

44. Franciscan
Savings
Impact
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.
Source:
Healthcare
Kaizen

45. Ideas
vs.
Sugges)ons
“
SuggesDons
are
things
I
think
you
should
do…
Ideas
are
things
that
I
can
do.”
-­‐
Norman
Bodek
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.

46. Q&A
/
Contact
Info
• Email:
mark@LeanBlog.org
• Blog:
www.LeanBlog.org
• Startup:
www.KaiNexus.com
• TwiTer:
www.twiYer.com/MarkGraban
• Books:
– www.LeanHospitalsBook.com
– www.HCkaizen.com
• www.Hckaizen.com/kaizenpreview
©
2012
Mark
Graban
and/or
Joseph
E.
Swartz.
All
Rights
Reserved.