Subject: Rethinking Kaizen Improvement in Healthcare

What is Kaizen?

It has been well over a decade since healthcare companies began to adopt Lean-Six Sigma methods to improve operational performance and bring down their cost structure. Initially, healthcare reform served as the catalyst for improvement efforts across the industry. This was followed by continued competitive and regulatory pressures.

Enter: consultants, long, improvement meetings, and process flow-charts compiled by hundreds of managers, analysts, and associates. Healthcare leadership is told they must wait months before meaningful insights are shared; let alone tangible results produced for the organization. The objective of these “Kaizen” improvement meetings is to promote business value.

For decades, Lean-Six Sigma practitioners have turned to the rapid improvement method known as “Kaizen”. Kaizen is a Japanese term which means “change for the better.” The process includes a series of one-week long “Kaizen events” during which participants uncover short-duration improvement projects. Kaizen events seek to include all the key subject-matter-experts (SMEs) and decision-makers in the room who are empowered to solve targeted organizational pain points.

Why won’t traditional Kaizen methods work with healthcare?

While traditional Kaizen concepts translate successfully within healthcare organizations, traditional Kaizen methods do not for the following reasons:

1. Requires Large Blocks of Stakeholder Time: The traditional Kaizen one-week intensive event is nearly impossible for most healthcare organizations, since most SMEs and decision-makers are spread too thin to commit one week away from their daily responsibilities several times a year.
2. Long Implementation Cycles: Traditional Kaizen events include a deep-dive review of targeted operational pain points, including data points, process flows (“current state” and “future state”), and causal analysis exercises involving several layers of people, process and technology. The time horizon for implementing changes are bucketed as now, up to 30 days, 31-90 days, or > 90 days. A traditional Kaizen event can require weeks of preparation– consuming even more SMEs and decision-maker time.
3. Too Much Scope: There is extraordinary pressure on healthcare organizations to improve their operating performance and achieve rapid results. Achieving tangible improvement in healthcare requires focus and consistency. Traditional Kaizen events seek to tackle multiple business processes and pain points involving several stakeholders. Too much improvement scope can commonly translate to zero results in healthcare.

A variation of the traditional Kaizen method is needed within healthcare to deliver rapid business value.

The mini-Kaizen: The More Effective Approach 

There is a better way – the mini-Kaizen. The mini-Kaizen concept accepts the reality that most healthcare companies are huge organizations with long-entrenched cultures. Healthcare companies do not have the organizational capacity for enterprise improvement programs with long wait-times. Instead, improvements must be made iteratively, consistently, and within an achievable scope. The time of key SMEs and decision makers is valuable and must be optimized. Over time, mini-Kaizen’s small, daily and weekly improvements lead to substantial long-term gains to the member value stream.

The mini-Kaizen is a 4 to 8-hour improvement event that includes the following guidelines:

• Scope: 1 operational pain point maximum
• Causal Analysis: limited to 5 “Whys” (ex: no fishbone diagrams)
• Process Level: typically limited to level 1 process diagrams (gathered prior to the event)
• Pain Points: identified against “current state” process diagrams (analyzed prior to the event)
• Data: business impact data points limited to level 1 pain points (gathered prior to the event)
• Implementation Timeline: no improvement areas discussed beyond the 30-day horizon
• Dependencies and Constraints: final lists completed at the event (drafted prior to the event)
• Cadence: one 4 to 8-hour event every 30 days

Case study: mini-Kaizen Success at Blues

One large west Coast Blue Shield health plan made significant inroads in maturing their infrastructure operations leveraging the mini-Kaizen concept. The company acknowledged the resource constraints and lack of organizational will to endure several week-long traditional Kaizen events a year. The scaled-back time and scope of mini-Kaizen allowed the company to focus on what could be achieved quickly rather than creating an enormous backlog of work to implement later.

In Conclusion: Why mini-Kaizen Works

The mini-Kaizen method draws upon the best of Lean-Six Sigma (including Kanban) and Agile, while also recognizing the realities of the modern healthcare operation. Real improvement results are delivered in a small yet consistent flow of iterative improvements that combine to achieve tangible impact and business value.

Effective facilitation is critical to the success of a mini-Kaizen event and will be the subject of a future blog post.