Japanese improvement

From HMCwiki

There is a lot to be learned from Japanese improvement methods. Too often we limit ourselves in improving our work duties because we think the important changes have to make significant savings to be worthwhile. The Japanese have long since proven that the best ideas are small ones and that it’s the accumulation of these small ideas that have the largest impact on improving quality. Perhaps this is why in the 90's the Japanese worker registered 32 ideas per year while the American worker loged about one idea every seven years. There is a hidden potential in each worker who desires to get rid of unnecessary steps and avoid duplicate efforts. The following are healthcare examples of some techniques the Japanese use to generate improvement and move toward a problem-free environment.

Kaizen

Kaizen is the Japanese term for small improvements that save only a few minutes here and there, but amount to untold hours of reduced frustration. A nurse in an operating room was fed up with the trash liner coming loose from the hamper every time she tossed in a few items. After unsuccessfully trying to order a different size bag to fit more tightly over the hamper, she came up with the kaizen of ordering an industrial-size rubber band that fits around the lip of the hamper.

The staff members in an obstetric unit were tired of giving student nurses telephone numbers. So they made a list of the 20 most frequently called extensions and clipped it behind the student’s identification badges. This may save only seconds thumbing through a phone directory, but it is unnecessary work they were glad to eliminate.

Another kaizen came from a unit secretary who was wondering why she had to unpad various forms coming to the unit. Why couldn’t they be delivered single sheets from the print shop? This question changed the print shop’s practice of padding forms to sending them individually in shrink-wrap packages.

Quick Changeover

Have you ever watched a racecar and wondered how a car can drive into the pit, have its tires changed, windshield washed and fuel filled in only 17 seconds? It’s called quick changeover and it’s accomplished by identifying which steps of the operation are external to the pit stop system and which are internally essential. Those that are external can be prepared ahead of time or pre-set for the most efficient order. Those that are internal must be performed at the time of the pit stop. Using this process, the Japanese have been able to reduce expensive machine set-up times from four hours to four minutes. A healthcare example is the preparation needed for receiving postoperative surgical patients from the ICU. Internal to the system is the bed transfer of the patient, the critical hookups and stabilization of the patients as they come to the floor. What can be made external to the system is securing the suction equipment, IV poles, adjusting furniture, assembling the forms, even having the forms stacked in the sequence of their completion. Every minute, every thought that is made external to the system reduces the time it takes to stabilize the patient and sends the transferring staff along their way. Another way to understand Quick Changeover is viewing it as [[Cycle Time Reduction]|cycle time reduction]].

Visual Control

Setting up visual controls is a method that places color, instructions, pictures, etc. into the workplace to visually help the employee do the job right.

This was tried in an operating room area, where a five-minute scrub is required. To help those scrubbing for the case pass the time, nurses installed Plexiglas frames for information about new products, and new procedures for the staff and doctors to see every morning.

In another case, a nursing unit developed its own physician post-it note to highlight communications from the nurses. Elsewhere, a unit made a doctors’ signature conversion of the doctors whose signature were difficult to read. The physicians signed beside their typed name, and the list was laminated and placed next to the charts for interpretation.

These are just a few examples of how visual controls can be put into practice, and there are many more.

Poka-Yoke

Another Japanese word, Poka-Yoke refers to mistake-proofing or designing a system that can work only one way, -- the right way. In fact, it should be odd if it’s performed the wrong way.

A nurse was frustrated because at the end of the shift, the student who was assisting didn’t know to complete all the weights and associated documentation. The nurse sat down, made a list of expected duties that needed to be done. This was shrunk to a pocketsize card for reference. The nurse reviewed the list with the student prior to the shift, making sure all the aspects of her responsibilities were covered. A more advanced sheet was made for float nurses to explain the unique patient requirements specific to the unit. Both these sheets eliminated errors from presumed thinking.

A Japanese proverb says, “A mountain is made of many specks of dust.” By making small improvements, a healthcare workers can chip away at the mountains of wasted hours, frustration, and delay. Challenge yourself today and see how many small improvements can be generated and put into practice. It will ease your work routine and give you more time to do your job well.

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