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Pub. Date:
Taylor & Francis
Pub. Date:
Taylor & Francis
Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements / Edition 1

Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements / Edition 1

by Mark Graban, Joseph E. Swartz Mark Graban
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Healthcare Kaizen focuses on the principles and methods of daily continuous improvement, or Kaizen, for healthcare professionals and organizations. Kaizen is a Japanese word that means "change for the better," as popularized by Masaaki Imai in his 1986 book Kaizen: The Key to Japan’s Competitive Success and through the books of Norman Bodek, both of whom contributed introductory material for this book.

Winner of a 2013 Shingo Research and Professional Publication Award!

In 1989, Dr. Donald M. Berwick, founder of the Institute for Healthcare Improvement and former administrator of the Centers for Medicare & Medicaid Services, endorsed the principles of Kaizen in the New England Journal of Medicine, describing it as "the continuous search for opportunities for all processes to get better." This book shows how to make this goal a reality.

Healthcare Kaizen shares some of the methods used by numerous hospitals around the world, including Franciscan St. Francis Health, where co-author Joe Swartz has led these efforts. Most importantly, the book covers the management mindsets and philosophies required to make Kaizen work effectively in a hospital department or as an organization-wide program.

All of the examples in the book were shared by leading healthcare organizations, with over 200 full-color pictures and visual illustrations of Kaizen-based improvements that were initiated by nurses, physicians, housekeepers, senior executives and other staff members at all levels.

Healthcare Kaizen will be helpful for organizations that have embraced weeklong improvement events, but now want to follow the lead of ThedaCare, Virginia Mason Medical Center, and others who have moved beyond just doing events into a more complete management system based on Lean or the Toyota Production System.

It’s often said, without much reflection, that people hate change. The experiences shared in this book prove that people actually love change when they are fully engaged in the process, get to make improvements that improve patient care and make their day less frustrating, and when they don’t fear being laid off as a result of their improvements.

Mark Graban explains why his new book Healthcare Kaizen is a great resource for healthcare organizations looking to make improvements on the frontlines.(

Check out a recent entry about this book on the Virginia Mason Medical Center Blog, Could this new book help drive your Lean journey? (

Check out what the experts at the Franciscan St. Francis Health System have to say about Healthcare Kaizen. (

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Product Details

ISBN-13: 9781439872963
Publisher: Taylor & Francis
Publication date: 06/21/2012
Edition description: New Edition
Pages: 408
Product dimensions: 8.30(w) x 10.90(h) x 0.80(d)

About the Author

Mark Graban is an author, consultant, and speaker in the field of lean healthcare. He is the author of Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Second Edition. Mark has worked as a consultant and coach to healthcare organizations throughout North America and Europe. He was formerly a senior fellow with the Lean Enterprise Institute and continues to serve as a faculty member. Mark is also the Chief Improvement Officer for KaiNexus (, a startup software company that helps healthcare organization manage continuous improvement efforts. Mark earned a BS in Industrial Engineering from Northwestern University and an MS in Mechanical Engineering and an MBA from the MIT Sloan Leaders for Global Operations Program. Visit his website at and his blog at

Joseph E. Swartz is the Director of Business Transformation for Franciscan St. Francis Health of Indianapolis, IN. He has been leading continuous improvement efforts for 18 years, including 7 years in healthcare, and has led more than 200 Lean and Six Sigma improvement projects. Joseph is the co-author of Seeing David in the Stone and was previously an instructor at the University of Wisconsin. Joseph earned an MS in Management from Purdue University as a Krannert Scholar for academic excellence.

Table of Contents


Kaizen and Continuous Improvement
Kaizen = Change for the Better
Bubbles for Babies
Kaizen: A Powerful Word
Kaizen Is Not Just Change, It Is Improvement
We Often Succeed As the Result of Failing More
Kaizen, PDSA, and the Scientific Method for Improvement
Changing Back Can Be Better For Babies
Kaizen = Continuous Improvement
Kaizen Starts with Small Changes
A Small Kaizen with Great Meaning
Kaizen = Engaging Everybody in Their Own Change
Kaizen Upon Kaizen Upon Kaizen
Kaizen Closes Gaps Between Staff and Leaders
Creativity before Capital
Expensive Mistakes Made without the Kaizen Mindset
Kaizen and Lean: Related and Deeply Interconnected Concepts
People Are the Ultimate Competitive Advantage
High-Level Kaizen Principles—The Kaizen Mindset
This Is Not a Suggestion System—It Is an Improvement System
Kaizen Has an Impact on People and Performance

The Roots and Evolution of Kaizen
Early Suggestion Programs
Downsides of Suggestion Box Programs
Recovering from Taylorism
The American Roots of Continuous Improvement—TWI and Deming
Kaizen: One of the Two Pillars of The Toyota Way
Masaaki Imai and the Spread of Kaizen (1986)
Dr. Donald Berwick’s Call for Kaizen (1989)
"Medicine’s Need for Kaizen" (1990)
Norman Bodek and American Kaizen
Discussion Questions

Types of Kaizen
The Continuous Improvement of a Lifesaving Innovation
Three Levels of Kaizen
Imai’s Three Levels of Kaizen
Complementary Nature of the Levels of Kaizen
Three Types of Kaizen at Children’s Medical Center Dallas
Events Alone Will Not Make You Lean
The Origins of Kaizen Events
Basic Structure and Format of an Improvement Event
Impressive Results from Kaizen in Healthcare
Virginia Mason Medical Center
Criticisms of Weeklong Events
Not All Kaizen Organizations Rely on Events
Kaizen Leads to Innovation at Franciscan

Moving Toward a Kaizen Culture
The Real Goal—Cultural Transformation
What a Kaizen Culture Feels Like
Everyone Is Engaged
Drivers of Engagement
Everyone Is Relentlessly Searching for Opportunities to Improve
The Two Parents of Transformation: Pain and Possibility
You Have Control over Your Workplace
Patients and Families Are Happy
Staff and Physicians Are Happy
Work and Patient Care Flow Like Clockwork
The Workspace Is Clean, Orderly, and Safe
Everyone Works Together
Everything Gets Questioned
Small Successes Lead to Bigger Successes
Small Kaizen Leads to More Big Ideas
Bite-Size Chunks
Imai’s Three Stages of Kaizen


Quick and Easy Kaizen
How to Do Kaizen
Quick and Easy Kaizen
Starting the Franciscan Kaizen Journey
The Quick and Easy Kaizen Process
Step 1—Find
Start Small
Start With You
Make Your Work Easier
Make Your Work Safer
Make Your Work More Interesting
Build Your Skills, Your Capabilities, and Your Knowledge
See an Opportunity or a Problem
Step 2—Discuss
Discuss with your Direct Supervisor
Discuss with Your Team Members
Quantify the Idea
Step 3—Implement
Enrolling Others to Help
Implement the Improvement Idea
Seven Days Grace
Step 4—Document
Finalize the Kaizen report
Submit Report For Approval
Step 5—Share
Leveraging Improvement Ideas from Others
Sharing Kaizens

Visual Idea Boards
Making the Improvement Process Visible
Setting up a Visual Idea Board
Boards Should Be Highly Visible in the Workplace
Boards in "Public" Settings
Communication That Should Occur before the Visual Idea Board Is Put Up
What Happened to the Suggestion Box?
What Employees Can Expect
A Communication Example
Formats for Idea Cards
Sticky Notes versus Structured Cards
Idea Cards versus Suggestion Cards
Modeling the Kaizen and PDSA Process in Writing
Visual Idea Cards
Suggestion or Idea
Date Originated
Created By
Expected Benefits
Input Needed From
Implementation Steps
Results Verified?
New Method Standardized?
Completion Date
Idea Card Examples
Staff and Patient Annoyances
Asking for Help
Addressing Patient Needs
Getting Input from Others
Other Formats of Idea Boards and Cards
Park Nicollet’s KEEP Form
Akron Children’s Hospital
Seattle Children’s Hospital Pharmacy
Visual Management of the Idea Boards
Using Idea Cards to Coach People on Kaizen
The Suggestion to "Be More Careful"
Something’s Not Happening—So Don’t Forget
Easier for Us, but Not Best for the Whole System?
Tracking Completed Cards

Sharing Kaizen
Different Formats for Sharing
The Kaizen Wall of Fame Format
Kaizen Sharing Examples
Making Things Better for Patients
Supplies for Patients
Improving Meal Rounds
Easier to Get DVDs
Little Details for Patients
Preventing Mistakes or Harm
Ensuring Proper Bed Cleaning
Preventing Pressure Ulcers
More Accurate Lab Results Through Standardized Work
Proper X-Ray Ordering
Ensuring Equipment is Ready
Eye Protection for Lab Staff
Preventing Aerosolized Specimens
Making Work Easier for Staff
Easier to Plug In Carts
Improved Ergonomics and Specimen Quality
Saving Sore Feet
Better Phone Ergonomics and Productivity
Combining Two Forms Into One
Preventing Delays
Faster Code STEMI Heart Attack Care
Meds for Discharged Patients
Getting Patients to Rooms with Less Delay
More Timely Test Results for Rounding
Fewer Supply Chain Delays
Better Access to Endocrinology
Saving Space or Cost
Creativity over Capital in the Lab
Company Medical Clinic Costs
An Unnecessary Label
Rethinking Freezer Use

The Art of Kaizen
Barriers to Kaizen
Resistance to Change
Lack of Time—We’re Too Busy
A Model for Mobilizing Support
Tenet 1: Respect Others
Tenet 2: Create a Vision That Matters
Tenet 3: Convey the Why
Tenet 4: Connect to the Mission
Is This About Me or Is This About the Mission?
Working with Others Based on Their Willingness to Invest
Strategy 1: Cocreate with Those Eager for Opportunity
Seek Their Ideas
Play Kaizen Catch Ball
Reigniting Everyone’s Creativity
Strategy 2: Sell Opportunity to Those That Are Cautious
Seven Days Grace
Measure Progress
Strategy 3: Find Common Meaning with and Negotiate with Opposers
Include Opposing Viewpoints
Find Common Meaning
Use Demands as a Last Resort
Kaizen and Positive Deviance
Rules for Leaders


The Role of Leaders in Kaizen
Leading to Create the Culture
Key Actions for Leaders at All Levels
Key Action 1: Believe In the Power of Kaizen
Key Action 2: Participate in Kaizen
Key Action 3: Just Ask
Ask, Don’t Tell
Key Action 4: Use Kaizen to Develop People
Key Action 5: Ensure Staff Members Are Recognized and Rewarded
Key Action 6: Share and Spread Ideas
Key Action 7: Sell the Benefits
It Is Not Always about Cost
Role of Top-Level Managers
Leadership and Kaizen Participation Starts at the Top
Dr. John Toussaint’s Participation
Going to the Gemba
Kaizen Reports Are for Everybody
Key Actions for Top-Level Managers
Key Action 1: Communicate Expectations and Prioritize
Key Action 2: Resource Adequately
Key Action 3: Sponsor a Recognition and Incentives Program
Key Action 4: Share Notable Kaizens
Key Action 5: Thank People Personally
Role of Middle-level Managers
Paula’s Baby Steps Lead the Way
The "Great Big Pile of Problems"
Leaders Drive Kaizen Success
The Kaizen Difference
Key Actions for Middle-level Managers
Key Action 1: Be the Departmental Owner and Develop Co-Owners or Coordinators
Key Action 2: Use Departmental Meetings
Key Action 3: Encourage Staff to Participate by Asking for Their Ideas
Key Action 4: Create a Departmental Recognition System
Key Action 5: Put a Tracking System in Place, If One Does Not Exist
Key Action 6: Tie to Performance Evaluations
Role of First-Level Managers
A First-Level Manager Is a Coach
Key Actions for First-Level Managers
Key Action 1: Coach
Key Action 2: Empower Staff—Do Not Do the Kaizen for Them
Key Action 3: Use Rounding to Coach
Key Action 4: Help Set Expectations
Key Action 5: Review and Approve Kaizen Reports
Key Action 6: Help Document Benefits
Key Action 7: Make Kaizen Fun
Key Action 8: Recognize and Reward
Key Action 9: Share and Spread Ideas
Key Action 10: Be a Cheerleader

Organization-Wide Kaizen Programs
Getting Started
When Will You See Results?
Tying Kaizen to the Organization’s Strategy
The Kaizen Promotion Office
Staffing the KPO
Activities of the Kaizen Promotion Office
Activity 1: Facilitates the Practice of Kaizen
Activity 2: Reports Kaizen Metrics
Activity 3: Coordinates Rewards and Recognition
Activity 4: Facilitates Kaizen Sharing across the Organization
Activity 5: Develops Kaizen Standardized Work
Activity 6: Develops and Delivers Staff Education
Activity 7: Facilitates the Documentation and Tracking of Kaizens
Sustaining a Kaizen Program—Incentives and Rewards
Pros and Cons of Financial Incentives
Electronic Kaizen Systems
Advantages of an Electronic Online Database
Quick Entry
Automatic Routing and Electronic Approval
Ideas to Hold for Later
Quick Search and Retrieval
Electronic Kaizen within Intermountain Healthcare
Electronic Kaizen at Park Nicollet
Electronic Kaizen at Vanderbilt

Lean Methods for Kaizen
Technique 1: Add Value
The Internal Customer’s Point of View
Different Forms of Patient Value
Technique 2: Eliminate Waste
Waste 1: Transportation
Waste 2: Overproduction
Waste 3: Motion
Waste 4: Defects (Errors and Rework)
Waste 5: Waiting
Waste 6: Inventory
Waste 7: Overprocessing
Waste 8: Lost Human Potential, Creativity, and Opportunities
Seeing Waste Through Process Observation
"Go See"
Spaghetti Diagrams
Technique 3: Visual Workplace
Color Coding
Home Locations
Kitchen Example
Technique 4: 5S—Workplace Organization
S1: Sort
S2: Set in Order
S3: Shine
S4: Simplify and Standardize
S5: Sustain
Technique 5: Workstation Design
Technique 6: Problem Solving
A3 Problem-Solving Technique
Example Problem-Solving A3
Problem-Solving Methods Used with A3
Find the Point of the Cause
Identify the Root Cause
Technique 7: Error Proofing
Fatal and Preventable Healthcare Errors
Four Elements of a Zero Defect Quality System
Element 1: Self-Check and Successive Check
Element 2: Immediate Feedback and Corrective Action
Element 3: Source Inspection
Element 4: 100% Inspection

Kaizen At Home
Kaizen Tips from an Actress
Kaizen Tips from a Behavioral Scientist
Kaizen at Home
Kaizen before Work
Kaizen for Breakfast
Kaizen to Get Ready for Work
Kaizen with Your Coffee
Kaizen to Get Dressed
Kaizening Cup Clutter
Kaizen on the Way to Work
Kaizen in the Home Office
Kaizen on the Computer
Kaizen on the Physical Desktop
Kaizen after Work
Kaizen for Dinner
Kaizen in the Backyard
Kaizen Home Repair
Kaizen for the Earth
Kaizen in the Bathroom
Kaizen and Your Kids
A Vacation from Kaizen?
Kaizen for Repetitive Tasks
Kaizen for the Kaizen Process

A Minute to Learn, a Lifetime to Master
Your Next Steps
Building a Kaizen Community

Each chapter includes a Conclusion, Discussion Questions, and Endnotes

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