Lean process improvement methodologies are finding their place not just in manufacturing but in the clinical setting, where removing inefficiencies benefits not only the hospital but the patients themselves. Kaizen, which means "rapid improvement for the best" in Japanese, focuses on continually improving and standardizing processes based on the input of everyone involved in the work itself — from the hospital's chief of staff to the nurses and even the custodial staff.
Breaking down barriers
As a physician and chief of neonatology with more 35 years of experience, I strongly believe physicians operate in a microcosm and often see but do not integrate the different perspectives and challenges of complex systems present in our workplace. We have our own language and our own way of communicating with each other, but we can be resistant to new terminology, which is why Kaizen presents a very real challenge to leverage in a hospital setting. Kaizen is rooted in the business world, which has its own lexicon and can seem like learning a different language.
However, once Kaizen is explained to physicians in terms they understand, these leaders can begin to see multiple solutions to the challenge at hand. Physicians who are familiar with the Kaizen event's goals can function as a bridge for all individuals involved in the process. In this way, he or she can create the environment that allows for visualization and analysis of the issues and support a culture that permits open communication, respect for all team members with the common goal of improvement, and value for all. This is why a Kaizen facilitator is another necessary member of any event. Interdepartmental communication is often a sticking point at many hospitals, but Kaizen integrates different sectors of the hospital, breaking down communication silos and setting aside traditional barriers that can prevent teams from finding ways to more effectively assist patients. By setting up this structure that fosters open communication and promotes the idea that everyone's opinion is an important opinion, processes can be examined more closely. Here, Kaizen changes the traditional dynamic and guides the team to find solutions to seemingly complex problems in the clinical setting.
Streamlining the outpatient process
A Kaizen is usually a three-to-five day event that requires the hospital's executive sponsorship, physician-led multidisciplinary teams, a bias for action, use of value stream mapping and other Kaizen tools, and measurable results to overcome obstacles that are hurting patients and the bottom line. These solutions may be as small as allowing an outpatient to remain in the waiting room while lab results are pending, or as large as streamlining the way ER patients are seen and discharged.
For example, at a South Florida radiology department, the picture was not pretty. After the patient signed in, he would get his vitals checked and blood drawn, and then wait for the lab results before his procedure. In this scenario, he waited alone in a bed with an IV drip for one to two hours, not only occupying space that could be used by a patient whose blood work was completed, but also separating the patient from his family.
Using Kaizen, we streamlined this radiology process by implementing a communications structure among the registration desk, lab, physician and nurses. After mapping the original flow, the hospital was able to realize the patient did not need to lay down for two hours prior to seeing radiology. Instead, the hospital could have the patient's lab work conducted in an outpatient setting, then release the patient to wait in the waiting room with family while the lab work was completed. Now, when the lab work is ready, the patient is given the IV, his radiology procedure is done and he goes home. It is a small change, but it allows the hospital to better utilize the radiology suite and improve the patient's experience and overall satisfaction. And in this new process, radiology wait times for the patient have been decreased by at least 40 minutes.
Improving neonatology where every second counts
Another example in a completely different setting involved the role of the neonatology inside and outside of the newborn ICU. Here, the neonatologists were often pulled away from the NICU before they were needed, which left them waiting in a delivery room, instead of providing care in the NICU.
Often, neonatologists get to the delivery room to evaluate a distressed newborn only to find that the mother is not ready to deliver, and the obstetrician has not yet arrived. In other cases, the equipment is not set up for delivery. The neonatologist wastes time making phone calls, locating other professionals and equipment, which not only takes away from his or her time caring for other newborns but also creates a stressful atmosphere in an already difficult situation.
Running a Kaizen event in this scenario meant gathering representatives from different departments involved in the process, including obstetrics, anesthesiology, newborn ICU, respiratory therapy and nursing to review and design a process that would provide the best support for a newborn who was likely to be born sick. Ideally, because of the parents' unique role in the NICU, it's important to include them in the Kaizen process. While the neonatologist's primary role is to care for the newborn, the parents are just as critical to the baby's care, and involving them helps find solutions that will further assist this difficult time for the family.
During this Kaizen event, a standard work flow for communication between the different departments was created. All these steps created better communication between obstetrics and NICU, allowing a smooth flow from the moment the mother comes in to the time the infant is born. One of the tangible items to come out of this Kaizen was a video that illustrated how to prepare the resuscitation bed for the newborn, as well as a flow process to improve communications and notify the appropriate physicians. Now, the neonatologist does not have to stop treating patients in the NICU and wait half an hour for a mother to deliver, scrambling to find what he or she needs to care for the new arrival. Instead the equipment is ready when the neonatologist gets there, and he or she is able to spend more time with patients and their parents. According to the leadership in that institution, after the Kaizen event, there was a significant improvement in communication between different departments and satisfaction among physicians and nurses improved based on the new flow of the department.
As demonstrated by these examples, solutions involve participation from every member of the team. Kaizen stresses respect, and one of its main rules is that no one has a title. Those designated as leaders are there to guide the process, not dominate it. It can be a humbling experience to bring together the department chief as well as nurses, IT staff or custodians to further a common goal. It's also a fruitful experience, as sometimes the person who cleans the OR after the procedure has the best solution for a problem. Everybody has an equal voice in making the hospital more efficient and a better environment for patients. And that is the key to making improvements stick.
Luiz Grajwer, MD is a Kaizen clinical advisor with Sheridan Healthcare. He is a Board-certified neonatologist who pioneered newborn intensive care in Brazil and most recently practiced in South Florida. Dr. Grajwer received his medical degree from Universidad Federal de Rio de Janeiro Faculty of Medicine.