Organize for learning to make kaizen stick | Michael Ballé

“[…]the Quality Director would ask the nursing supervisor to track the time of first incision in each theater every day and share the results with surgeons. This simple measure increased OR usage by 20% in the first month. It also led to heated discussions among surgeons (why were some late and others on time?) and paved the way for further kaizen. But then one of the crises hospitals are so accustomed to came, and the practice was abandoned. Theater usage went back to what it was before.[…]”


Michel Baudin‘s comments:

The author is missing an essential point: changes that add labor are unsustainable. They will be reversed at the first emergency and rarely if ever reinstated once the emergency is over. Asking a nursing supervisor to track the time of first incision in each operating room meant adding to his or her work, without reducing anybody else’s. It was a change all right, but not a Kaizen.

Surgeons in front of Gilbreth's grid
Surgeons with grid used  by Gilbreth to track motion on film

100 years ago, Frank Gilbreth improved the performance of operating rooms by, among other things, having nurses supply tools and instruments to surgeons rather than having the surgeons leave the patient to fetch them. Work previously done by the surgeon was offloaded to nurses for the benefit of the patient, without any net addition of labor. It was a genuine improvement and became standard practice.

The author quotes Ohno as  saying  “Why not make the work easier and more interesting so that people do not have to sweat?” Adding record-keeping tasks does not fit that bill.

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