Quality Improvement Methods
22. Kaizen Events
a. Definition: Kaizen is Japanese word that means "improvement" or "change for the good" and it refers to improvement that is a cultural change and not just mechanical or limited adjustment. A Kaizen Event is a focused group working for a limited time on a specific improvement while following various Lean precepts. As a philosophy, Kaizen refers to continuous ongoing improvement involving all staff. An environment is intended which supports innovation and participation in change. Part of the idea of a Kaizen Event is to gather together a group of people who are familiar with a process area and an issue and then use the group to develop improvements to quality. They may be in a position to implement the change as well. Various successful formats have been developed and applied in healthcare. It is sometimes equivalent to Brainstorming, idea generation, Nominal Group Technique (see Section 24), or the Delphi method. The group's organization is designed to assure full participation and use of the group member's capabilities.
The Kaizen Event's duration should depend on the complexity and importance of the issue being addressed. In some cases it could involve only 2 or 3 people and be done in a few hours. In other cases a Kaizen can involved many more people and held for a full day or a week and repeated for several months. The Kaizen can be on site, at a hospital or a clinic, or off site. An onsite meeting may be more convenient and facilitate observation of current operations. Offsite may create more focus by the participants. It is not intended as an ongoing group meeting such as with a committee.
All the books on Lean include a substantial amount on Kaizen since it is an important element of the Lean method.
- Masaaki, Imai. "Kaizen: The key to Japan's competitive success." New York, McGraw-Hill (1986).
- Jackson, Thomas L. Kaizen Workshops for Lean Healthcare. Vol. 3. Productivity Press, 2012.
- Jacobson, Gregory H., et al. "Kaizen: a method of process improvement in the emergency department." Academic Emergency Medicine 16.12 (2009): 1341-1349. (as an example of Kaizen's use)
c. Example: A hospital wished to reduce its readmissions for patients with a particular diagnosis. They gathered a team from various areas in the hospital which may be involved with such patients. The team met over 5 full days. The event was led by someone who had led prior Kaizen Events. The leader provided guidance, particularly regarding the attitude and communications necessary for success. The meetings included analysis of the problem, using various Lean tools, developing solutions, picking the best ones and implementing the changes to improve quality. At the end, the team presented its work to management and a large segment of the hospital staff to encourage future Kaizen Events and to assure the recommendations were implemented.
1) Identify the issue to be addressed and select a cross-functional team to be gathered together in one place. Also identify a "champion" responsible for the results. The team is given goals but also given the freedom and time to develop its own solutions. The team should include all relevant areas and patients themselves can be very useful participants.
2) In the Kaizen meeting analyze the current state, the goal, and then if onsite observe current operations and quality directly. Often this involves creation of a process map (see Section 31) describing the existing or current state operations.
3) It is important that each meeting of the group, which could be daily, weekly or monthly, have the proper attitude. Fixed ideas about the past must be avoided and there must be freedom to ask "Why?" by everyone. Kaizen is a way of thinking.
4) Create improvements (which may require encouragement of members) and select preferred solutions. Develop a process map of the desired future state.
5) Identify metrics for success. SMART goals should be used (see Section 40)
6) Plan & implement (repeat if necessary). Get buy-in from parties related to the process. Implementation should be incremental with a "pilot" first step. This should be a change with a high likelihood of success following the PDSA idea.
7) Prepare standard work (see 42) as a way to sustain the change.
8) At the end, conduct a report-out to management or a celebration of the improvement with the entire staff, which helps sustain the results by informing and motivating everyone about the change.