Thanks to Quality Digest for publishing an article I co-authored with Gregory Jacobson, MD, a co-founder and the CEO of KaiNexus, a software startup I am working with as we go to market with web-based technology that helps initiate, manage, and spread ideas that come from clinicians and front-line staff.
You can read the full article, “Putting the ‘Continuous' Back into Health Care Continuous Improvement” on the Quality Digest website, but I'll share some related thoughts here. You can comment on their website or have some discussion with the crowd here.
The main motivation for the piece is our belief that the word “kaizen” has unfortunately become associated with weeklong improvement events. This often seems to be especially true in healthcare (where they might be called “rapid improvement events” or “rapid process improvement workshops.” Events might lead to improvement, but they're episodic, not continuous.
The word kaizen is sometimes translated from Japanese as “change for the better.” A successful and sustained event would fit into this definition. But the context for the word kaizen is most often about “continuous improvement,” as in small, low-cost, low-risk local improvements that are implemented by the people who do the work and their supervisor. Norman Bodek's “Quick and Easy Kaizen
Masaaki Imai's seminal book “Kaizen
I'll try to summarize my thoughts this way: kaizen events are not inherently bad. They are often mismanaged and become a slow, ineffective, bureaucratic slog. But they don't have to be. Kaizen events are, as you might hear in a cereal commercial, “part of this complete nutritious breakfast” that also includes kaizen as daily continuous improvement. As Imai says, everybody, everywhere, every day.
You can have your events… but maybe just leave the word kaizen out of it? You can call them “kaikaku events,” after the Japanese word for “radical improvement.” Let's reclaim kaizen for this staff-driven daily continuous improvement.
Note: Mark will be a guest on the internet video broadcast “Quality Digest Live,” with the editor of Quality Digest, Dirk Dusharme. I hope you can tune in.
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Great article! I’ve seen many companies (specifically in software development) that simply try to plug in a quality improvement initiative (like Six Sigma, CMMI, Agile software development, etc.) without actually changing the work culture. Most efforts succeed in the short run, but ultimately fail because the requisite culture change never happens.
I did want to ask you about this quote –
In your experience, does culture change lead to continuous daily improvement? Or does implementing continuous daily improvement lead to the culture change? Are they tied too closely together to distinguish?
Conal – thanks for your feedback. It’s very much a chicken-and-egg situation. But, I think you can start with small baby steps in culture change by practicing daily Kaizen.
Imai lays out a three-phase progression in his book “Kaizen”:
a. Stage I (1 to 3 years) participation and involvement are stressed – examine their jobs and think of ways to improve (supervisors say “yes” to virtually everything, to build enthusiasm)
b. Stage II (2 to 3 years) development and education to be better equipped to analyze problems (really start coaching people hard on better problem solving, root cause analysis, etc.)
c. Stage III (5 years after that) – begin to focus on economic impact of suggestions
That’s a relatively slow culture change, but maybe it’s a more sustainable one. Continuous improvement of the culture rather than radical shifts?
Having top leadership support these mindsets and ideas can lead to the radical shifts that might speed this culture up perhaps.
Here is a comment from John Toussaint, MD, former CEO at ThedaCare, shared here with his permission:
Mark – great article. I believe there is room for all 3 types of kaizen, the issue is most organizations don’t have them in the right balance and have an overemphasis on week long kaizen events.
Daily kaizen gets lost which is a shame since it has the power to engage many more people in the organization in Continuous Improvement.
Cheers
Good comment from a LinkedIn Group:
Horses for courses. Of course you want continuous improvement but the reality is you also sometimes need radical improvement and when you do, you need to down tools and put some real thought into it. Gather evidence. Map. Test. and so it goes.
Agree the word Kaizen should not be used and Kaikaku is a sensible replacement for this context.
Yes – was trying to make the point in the QD piece that events aren’t bad, there’s a place for events, and events can’t be the sole improvement approach.
[…] Mark Graban on August 19, 2011 · 0 comments After last week’s piece on “putting the continuous back into continuous improvement,” I had another article published this past […]
Nice article Mark. Your comments and those of John Toussaint, Conal, and Al are apropos of the ongoing challenges we in healthcare face in adopting and even more importantly, sustaining Lean principles within our organizations and within the industry as a whole. They can all be summed up in the word “Leadership.”
The challenges of Leadership in Healthcare becomes the challenge to Lean:
1. Constancy of Purpose and Profound Knowledge (two of Deming’s favorites) is often lost in the cacophony of marketing and branding terms designed to sell improvement methodologies and techniques.
We are all here to bring value to people’s lives around their health and wellbeing. When the language, tools, methodologies and overarching brand of improvement becomes more dominant, the core purpose gets pushed off center stage.
As a result, when the environment demands a dramatic shift in strategy and healthcare model, top leadership looses connection to the Lean tools and methods that they come to see as “not up to the task” of mastering the new challenge.
2. Strategic Imperatives: Engagement of the people closest to the work and the service, likewise begins to be treated by leadership as a “nice-to-have” component of survival rather than a “must have” of the new solution. Continuous Quality Improvement got thrown overboard in the past when leaders began to see it as the method for the middle or front line of the organization, not for the senior level challenges of competitive positioning, capital investment, payor management, profitability, and more.
Lean gives us another chance as an industry to infuse our organizations with the core improvement principles articulated by Deming, Drucker, Berwick, Womack, and others, and by companies like Toyota, GE, Ford, Intermountain Health, Harvard Community Health Plan, JCAHO, and ThedaCare.
My concern is not “can we adopt it?” I know we are and will continue to do so. My concern is “will we sustain it?” and “will we continually improve its effectiveness” in staying on top in the never ending leadership challenge of improving the value created by our healthcare institutions.
My humble hard earned wisdom: Lean (like “a rose, by any other name”) must be infused into the fabric of the work of Boards of Directors, Executive Teams, and Medical Leadership in our healthcare institutions and small businesses if we are to build value and maintain steady momentum as an industry.
[…] More organizations are focusing on daily kaizen not just events. As we document in our upcoming Healthcare Kaizen book, organizations like ThedaCare have shifted from a focus on weeklong events (“Rapid Improvement Events”) to also focus more on small daily continuous improvements. Weeklong events are fine, but they aren’t sufficient for transforming an organization, as I wrote about in my article “Putting the Continuous Back in Continuous Improvement.“ […]