QUERI – Quality Enhancement Research Initiative

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Quality Improvement Methods

19. Hoshin Kanri

a. Definition: This concept is using collective thinking to develop shared goals in order to improve the likelihood of success in a quality improvement effort. By following the structure developed as Hoshin Kanri there is a way to keep all the people involved at all levels of the organization focused on common long term goals. ("Hoshin" is Japanese for "compass" or "direction" and "Kanri" means "management" or "control.") It is also a particularly effective way to do policy deployment. Management sets overall goals for the organization and determines what gaps are particularly evident. These generate priorities (Hoshin) that become projects to deploy and measure against the overall goals. An important element is assuring that all the staff is aware of the direction intended and that they work in that direction.

Related to Hoshin Kanri is the idea of a "True North" or common direction for the many activities in a health care direction. For example, diverse activities such as the building layout, incentive pay and patient care must align with goals such as reduced medication errors or increased patient access.

Hoshin Kanri also often includes a leadership event to share goals and strategies in order to develop specific plans, perhaps related to certain value streams. Such a gathering, perhaps annually, to review if past plans were executed as intended and consistent with the goals or vision for the organization.

b. Literature:

  • Jackson, Thomas Lindsay. Hoshin Kanri for the lean enterprise: developing competitive capabilities and managing profit. Productivity Press, 2006.
  • Withy, Kelley, et al. "Assessing health disparities in rural Hawaii using the Hoshin facilitation method." The Journal of Rural Health 23.1 (2007): 84-88.
  • Hoshin Handbook, Third Edition by Pete Babich (2006)

c. Example: A health care agency responsible for a hospital uses Hoshin Kanri to plan and deliver health care in a more coordinated way across its service area. The agency found that it could do more to improve care by planning and working in a more coordinated way. At part of their Hoshin Kanri, they designed a web site to give everyone – public, providers and managers -- information on current quality results and their plans for further improvement.

In a second example, a hospital decided that it needed to create a culture whereby all parts of the organization were following the same vision. Otherwise, they were going to fall behind competitors. Not that everyone had to act in an identical manner, but more teamwork would lead to better results. The Hoshin Kanri approach was begun in a meeting of key leaders discussing their challenges and opportunities. Once it was clear where they wanted to go it was then possible to define everyone's role in achieving that vision and a way to measure how well they were succeeding. For this particular hospital they felt they must become more successful in performance improvement, among other things, and embarked on a long term plan of hiring and training in performance improvement methods.

d. Steps

The specific implementation approach varies by organization but there should be a focus on goals, good communications and recognition of the effort and time needed for successful policy deployment.

1) Define the organization's vision or goals in the form of a strategic plan. In this define near term objectives; for next year and for further out, perhaps 3 to 5 years

2) Determine priorities regarding needed improvements as well a metrics to measure success

3) Brainstorm possible solutions and specific tactics and prioritize them during a management gathering intended for that purpose

4) Take action, communicate and implement suggestions

5) Review the results and adjust as necessary