Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement

Abstract

ObjectivesKaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare.MethodsWe analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated.Results72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions.ConclusionsThere is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.

Structure Please; Continuous Improvement and Employee Consequences in a Dynamic Task Environment

“…However, these data also disclosed part of the underlying mechanisms: the CI program itself can also be the cause of annoyance, not because employees find it problematic in itself, but because not all peers conform to the new working methods agreed upon. The limited adherence to standards may undermine a CI program's sustainability when its supporters become frustrated [31]. Different reactions of employees also turned out to be crucial for the success of CI in a Spanish manufacturing firm [2].…”

Adapting Lean methods to facilitate stakeholder engagement and co-design in healthcare

“…Lean is derived from the practices of Japan’s automotive industry, specifically the Toyota production system 13. It is a systematic improvement approach that conceptualises work as processes that can be continuously improved by emphasising customer value and eliminating waste 613. Although it was developed for industry, it has been used successfully to improve quality and safety in acute, primary, and mental healthcare contexts (box 1).…”

“…The Lean method is one approach that is being increasingly used to enhance value in healthcare 567. In the UK, for example, NHS Improvement (which regulates NHS care providers) has embarked on a programme to embed Lean in English NHS trusts—some with support from the Virginia Mason Institute, a US based healthcare consultancy,8 and others with support from an NHS Improvement consulting team 9.…”

Electronic Clinical Decision Tools for Improving Adherence to Colon Cancer Surveillance Guidelines: Can the Chips Finally Fall Into Place?

“…11 Third, these programs should evolve with "continuous improvement"; the so-called Kaizen approach. 12 They should be extrapolated to consider differences in existing guidelines, adequacy of bowel preparation, family history, and quality of clinical and endoscopic data.…”