Toyota Kata in Health Care

I’m about four months into helping a major regional hospital develop a solid foundation for applying the Improvement Kata and Coaching Kata to learn “improvement thinking.”

They now have active improvement boards running in pre-op, post-op, surgery, radiology, the lab, the emergency department, the cardio-vascular floor, medical-surgery floor, ICU, cardiac rehab, billing, admissions, case management, and supplies. I think that’s everything going right now.

Several of these departments have more than one board, and a few are beginning to get started spontaneously.

We are starting to see the culture begin to shift in many of these departments. Staff are getting engaged in improving the work flows, administration team members are more engaged with the staff.

Directors and managers are starting to reach across organizational boundaries to deal with obstacles and problems at the departmental interfaces.

And the organizations are starting to shift how they talk. When confronted with a list of problems, leaders are starting to ask “OK, which one are we addressing first?” Leaders are asking “What do you expect to happen?” and “What did we learn?” when talking about actions. They are working to engage thinking in their organizations vs. just giving direction.

Is it all rainbows and unicorns? Of course not. But the effort is clearly being made, and it shows. My overall process coaching is getting much more nuanced, because they are “getting” the fundamentals.

OK, so what did we do?

We started out with two weeks of pretty intense “kick-start.” One week was half-days of training and simulation (with a morning and afternoon group), getting a feel for the rhythm of the improvement kata, and a taste of the coaching kata, and culminating with the first round of improvement boards getting set up with at least a direction, if not a clear challenge.

We deliberately did not use industrial examples. And now that I’ve done it a few times, I can incorporate more health care language and examples into the sessions, which just makes it easier.

Week two was pairs of learners/coaches being coached through grasping the current condition, establishing a target condition, and the first couple of PDCA cycles / experiments.

But what made it work is they kept at it.

The next month, we did it again. We coached the established boards to tighten up their game, while establishing a series of new ones.

Because they had kept at it, the first round of boards now had a routine for their improvement cycles and coaching. And once there is a pattern, then we can work on improving it.

What I am learning.

Just get them going, then leave them alone for a while to keep at it. That lets the team establish a baseline routine for how they are practicing. Then I can come back periodically and propose adjustments on one or two items that let them step it up to the next level.

I am finding this much more effective than demanding they get it perfectly from day one. There is just too much to think about.

Establish a target condition, have them practice to that pattern, grasp the current condition, establish a new target… for the team’s practice. Get the improvement engine running, even if roughly, then work on tuning it for performance.

To be clear, this is my normal approach (and it is different, I am told, from what a lot of others try to do), but I am getting a lot of validation for it here.

Results

A member of the administration (leadership team) who is actively coaching shared this chart with me today. I have “sanitized” it a bit. Suffice it to say these three lines represent the percentage of deliveries of three separate (but related) processes within or before the target turn-around time of 30 minutes. Their challenge is to turn 95% of them around in 30 minutes or less.

The vertical red line represents when they started applying the Improvement Kata to this process.

Otherwise, the picture speaks for itself.

image

They have recognized that there is no silver bullet here. Rather, there have been dozens (or more) of changes that each save a little bit of time that is adding up.

As one of my early Japanese teachers said “To save a minute, you must find sixty ways to save a second.” and that is exactly what they are doing here. They are finding a minute here, a few seconds there, and anchoring them in changes to the way they organize the work flow.

Lab Team: “Way to go!”

5 thoughts to “Toyota Kata in Health Care”

  1. Great story, Mark. Is it possible to share a “sanitized” photo of one of their improvement boards? A picture is worth a thousand words.

  2. Very inspiring story and amazing results. I’m curious about the environment that led the team to want to change. And I’m curious if it was hard for the team to make the time for both the two weeks of training and to continue to practice after the training. In my experience it’s one thing to teach, it’s another to get people to apply what they’ve learned – especially if they are under a lot of pressure to get stuff done. It’s so natural to revert to old habits.

    1. Why would the team want to change?
      It’s pretty rare, actually, to meet a team that says everything is as good as it can be. Usually the “resistance to change” is more a matter of feeling they have permission / support to be critical; or they’re overwhelmed by the sheer magnitude of “opportunities.” Sure, it there was some initial defensiveness about how things “have to be” but once people start really studying the current condition, they see things that they can change.

      As for making the time, the structure of the classroom training was deliberately set to only take them out for a few hours a day. The following week of practice wasn’t full-time either, and they were “grasping the current condition” in their own work areas, so it wasn’t like they were unable to respond to anything.

      Reverting to old habits is another issue entirely. That is why it is important to practice the thinking pattern on as many levels as possible – to establish new “old habits” of critical thinking. That is the hard part, because so many regard “Toyota Kata” as a “problem solving approach” which is a mindset that will guarantee keeping it contained vs spreading.

Leave a Reply

Your email address will not be published. Required fields are marked *