Tuesday, April 28, 2009

Going to Gemba

I have related below our efforts to spread the word about Lean techniques (aka Toyota Production System), for example to our residents, and apply them to the hospital setting. We're also conducting a similar set of training sessions for our senior management team.

For those not familiar with Lean, one of the concepts is "going to Gemba," where Gemba is the place that work is actually done, where value is created for the customer. By witnessing problems and work-arounds in real time, the team can have a better idea of how to solve problems to root cause and make incremental improvements in work flows. This is a critical part of a program of continuous process improvement, the theory behind BIDMC SPIRIT.

Here are (from top) Senior Vice Presidents Jayne Sheehan and Walter Armstrong following nurse Pam Moss, and Radiology Chief Jonny Kruskal following nurse Sarah DeCristoforo. The purpose of today's exercise was not actually to solve problems but to train our team in aspects of going to Gemba. As always, we all left with an enhanced appreciation for the dedication, outstanding work, and endurance of our nurses in the high-pressure environment of a medical-surgical floor.


Mark Graban said...

That's great, Paul!

One question that always comes up is "how much time at the gemba?" Toyota would always say "every leader at every level must spend time at the gemba."

How much time do you spend? What is your expectation for leaders at different levels?

How many times / week? How long of a gemba experience each time?

Thanks for sharing!

Anonymous said...

Just learning, Mark. Tune in later!

Anonymous said...

Ditto on the nurses. As for Lean, I realize the benefits of a standardized program such as Lean or Six Sigma in providing a road map for organizations seeking systemic and standardized improvement. However, "going to Gemba" sounds suspiciously like "management by walking around", which really is only common sense. In a hospital or other 24/7 operation, it's especially important to do this on the off shifts, which have unique issues of their own.
I once went on chart rounds with the lab employee responsible for placing the printed cumulative lab reports on each inpatient's chart on the night shift, beginning at 10 pm and ending around 0100. He had expressed "difficulties" in completing his mission, but his supervisor and manager seemed unable to explain to me what the difficulties were.
In one night, I found out, in spades. (The details are unimportant). In addition, it spread all around the lab that Dr. (nonlocal) stayed late at night to go around with a bench level employee - did wonders for morale and for my sources of information on other issues of concern. I highly recommend a night session of "going to Gemba."