Mark Graban - Kaizen Presentation for Spain

Layoffs Aren’t a Long-Term Fix • "After a year or so, the employee count is back up and the savings evaporate.” • "There has to be a better, longer lasting and less traumatic way to deal with such fiscal situations." Gary J. Passama, CEO NorthBay Healthcare (Fairfield, CA)© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Kaizen is for Everyone! “… emphasizes morale- boosting benefits and positive employee participation over the economic and financial incentives…” - Masaaki Imai© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Dr. Berwick’s Call for Kaizen (1989) – Kaizen = “the continuous search for opportunities for all processes to get better” • Dr. Donald Berwick – Founder, Institute for Healthcare Improvement – Former Administrator, Medicare and Medicaid (CMS) Citation: Berwick, DM, “Continuous improvement as an ideal in health care,” New England Journal of Medicine, 1989 May 25;320(21):1424-5.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

ThedaCare’s Collaborative Care Med Rec Errors per Chart Patient Satisfaction1.2 100% 1 80%0.8 60%0.6 40%0.40.2 20% n/a 0 0% 2006 2008 Traditional 2008 Collaborative 2006 2008 Traditional 2008 Collaborative Pneumonia Bundle Compliance Cost per Case120% $8,000 $7,000100% $6,00080% $5,00060% $4,000 $3,00040% $2,00020% $1,000 0% $0 2006 2008 Traditional 2008 Collaborative 2006 2008 Traditional 2008 Collaborative Source: Health Affairs© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Denver Health • “Denver Health Lean process has generated more than $135 million in financial benefit since 2006 (as of early 2012)” • Without those savings, Denver Health would "absolutely have had to cut jobs," CEO Patricia Gabow said.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

“What Sets Us Apart?” “Every Toyota team member is empowered with the ability to improve their work environment. This includes everything from quality and safety to the environment and productivity. Improvements and suggestions by team members are the cornerstone of Toyotas success.”© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Different Levels of Kaizen Very few Large issues System Kaizen Six Few Sigma Medium issues Lean Event Many Small issues Daily Kaizen Adapted from: “The Toyota Way Fieldbook,” Liker and Meier© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Kaizen Principles • Continually improve, with no idea being too small Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Kaizen Principles • A major source of quality defects is problems in the process Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Kaizen Principles • Focus change on common sense, low-cost, and low-risk improvements, not major innovations Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Kaizen Principles • All ideas are addressed and responded to in some way Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Kaizen Principles • Empower the worker to enact change Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Kaizen Principles • Collect, verify, and analyze data to enact change Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341- 1349, December 2009.© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Before / After Data from CMC Lab Before Lean 12 Months After Starting Lean 3. I have the opportunity to do what I do best every day. 3.11 3.92 8. I feel free to make suggestions for improvement. 2.84 3.48 10. I feel secure in my job. 2.32 3.42 13. Stress at work is manageable. 2.43 3.23 17. I am satisfied with the lab as a place to work. 2.51 3.43 18. I would recommend my work area as a good place to work to others. 2.38 3.46 Grand Average 2.96 3.69© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

# of Recorded Kaizens 4,500 4,225 3,951 4,000 3,500 3,000 2,822 2,500 2,046 2,000 1,500 1,000 500 281 - 2007 2008 2009 2010 2011© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Source: Healthcare Kaizen

Franciscan Savings Impact $2,000,000 $1,738,161 EMR $1,500,000 $1,000,000 $887,491 $925,518 $667,238 $500,000 $190,000 $- 2007 2008 2009 2010 2011© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Source: Healthcare Kaizen

Q&A / Contact Info • Email: mark@LeanBlog.org • Blog: www.LeanBlog.org • Startup: www.KaiNexus.com • Twitter: www.twitter.com/MarkGraban • Books: – www.LeanHospitalsBook.com – www.HCkaizen.com www.leanblog.org© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.