For those who are new to continuous improvement, all of the terminology and improvement methodologies can get a bit overwhelming. Our experience is that a culture of improvement and innovation requires three things: leadership, method, and technology. Of course, we have a strong opinion about which technology is best, but which methodology makes the most significant impact in healthcare?
Trick question. Many - or even all - of them are valuable tools for improving financial and patient outcomes.
The Urgent Need for Disciplined Improvement Work in Healthcare
Embarking on the quest for continuous improvement is a requirement for today’s healthcare organizations. The competitive, financial, regulatory, and technology landscape is complex and ever-changing. Healthcare organizations must be hyper-vigilant to the needs of patients and constantly aware of processes related to administration, facilities, finance, reporting, and more. Success calls for collaboration and leadership.
While the idea of continuous improvement is not new, modern healthcare organizations take a structured approach to achieving performance excellence by deploying using the ideas that have provided structured improvement in manufacturing for decades. Many techniques are borrowed from the Lean business methodology.
It Starts With Daily Kaizen
This kaizen style is sometimes called “continuous daily improvement” -- it’s the methodology from Masaaki Imai’s book KAIZEN, a journal article written by our CEO Dr. Greg Jacobson, and the Healthcare Kaizen books that I wrote with Joe Swartz. The ideal is having everybody involved in improvement, everywhere and every day. Many of these improvements are “just do its,” as they involve a small, simple problem requiring a simple solution that we test following the Plan, Do, Study, Adjust (PDSA) model.
Some are skeptical of the value of everybody solving minor problems. However, some issues are indeed more extensive and more complicated. They require more effort and a more rigorous methodology.
A3 Thinking in Healthcare
If a problem is relatively small and has an obvious countermeasure that can be tested, it’s probably a daily kaizen improvement. If there’s a problem without an obvious solution, that might become an “A3” project. Although the A3 approach gets its name from the European size of the paper used initially to document the project, the point isn’t about the paper. It’s about a way of thinking and problem-solving. We make sure we properly define the problem and have some measurable gap between our desired performance and actual performance.
In the A3 approach, teams do a more detailed study of the current state process. They usually need to do root cause analysis, utilizing fishbone diagrams or the “5 whys” approach. There’s a lot more work involved before we get to a solution to test (remember, this is still PDSA). Not every problem can be solved through the daily kaizen process, but don’t force everything to be an A3 either.
A key benefit of using the A3 method in healthcare is that everyone comes to know what to expect from an A3 report. No matter what the problem is, the sections covered in the report will be the same. The following topics typically included are:
Header: Summary information about the team and project.
Background: A description of the problem and comment about why a solution is needed.
Current State: Details of the situation as it is today. This section may include graphs and images. It is always based on data, never assumptions.
Problem: This section includes an analysis of the current state. The team defines the root cause of the problem so that improvements will result in better results.
Future State: This section describes the specific goals and any countermeasures planned.
Implementation Plan: This is the action plan and timing of the project. It includes Who, What, When, and Where. It should also define reporting plans for the project.
Results: After the improvement is implemented, the results are compared to the initial plan, and the team analyzes the total impact of the project. Results may include cost reduction, better patient outcomes, reduced waste, reduced wait times, any other business objective of the organization.
These events, often called “Rapid Improvement Events” or “Rapid Process Improvement Workshops” (that’s a mouthful) in healthcare, are more involved than daily kaizen improvements. Events involve a team of people from different functions or departments and they work full-time on a problem and testing a solution for anywhere from two to five full days. If daily Kaizen is “continuous improvement,” then events are “episodic improvement.”
Like the other approaches, events should follow the PDSA process. A team will take a relatively large problem, map the current process or value stream, do root cause analysis, collect data… working toward solutions they can test during the event.
Many organizations have only done events. That’s why Joe Swartz and I wrote our Healthcare Kaizen books - to encourage people to combine these methodologies. Just as everything doesn’t require an A3, not every problem requires an event. Use events when needed, for the bigger, more complex challenges.
Strategy deployment (or Hoshin Kanri) is a Lean approach for aligning goals and improvement efforts across an entire organization. This means that every person from the front-line staff to senior executives understands the organization’s primary goals, can relate them to their area, and strives to reach those goals through continuous improvement, A3s, projects, etc. Hoshin Kanri steers an organization toward long-term strategic objectives while maintaining and improving key business processes and results through systematic planning and good organizational alignment - both throughout the year and over multi-year cycles.
How the work is visualized and how it is organized play critical roles in having a successful strategy deployment effort. Lean software for healthcare helps by organizing all of your top-down and bottom-up work to ensure alignment with high-level goals. In addition, it increases visibility so that every person in the organization knows what strategic objectives are, how the organization is doing, and how their area is helping to attain those goals.
Daily kaizen, A3 thinking, kaizen events, and strategy deployment all help healthcare organizations apply Lean to ensure that improvement is a structured, data-based, and repeatable process.
No matter which methodologies you use, engagement is key.
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