Kaizen Method Can Improve Case Management
By Jeanie Davis
Efficiency and cost savings are worthy goals. Satisfaction also is relevant, whether applied to patients, frontline staff, managers, or chief executive officers. If your hospital workday is inefficient, satisfaction suffers at all levels.
That is where the Kaizen method can help, explains Karen Hooven, RN, BSN, CRRN, CCM, manager of case management at Cleveland Clinic Medina Hospital.
Kaizen is a Lean manufacturing tool that improves quality, productivity, safety, and workplace culture. Kaizen focuses on applying small, daily changes for major improvements over time. Kaizen is derived from two Japanese words: Kai (improvement) and Zen (good), which translates to “continuous improvement.”
Kaizen is relatively new to the healthcare industry, Hooven says. “Teamwork is a hallmark of Kaizen. We include everyone — not just the leaders and managers, but also frontline staff in making change.”
In the Kaizen process, caregivers analyze their environment, identify barriers, and develop a plan to remove those barriers — executing that plan quickly, she explains.
Questions include:
- Do you have the right equipment and the right supplies, at the right place, right time, right quality, and right quantity to keep work flowing smoothly?
- Is the process more difficult than it should be?
- Could the process be more efficient?
The overarching goal is creating a culture focused on improvement, Hooven adds. But an integral component is that “every caregiver feels capable, empowered, and expected to make improvements every day, and to sustain those improvements.”
In one instance, nursing staff were not receiving information discussed in nursing huddles. A Kaizen project was focused on that problem. “A formal process was developed, and now everyone is on the same page — simple as that,” Hooven explains. Assessing and reorganizing supplies among nursing units already has saved time and improved efficiency.
Overall, Hooven says, “we focus on making the job better so we’re not working as hard but getting things done. All staff are expected to participate. Because we engage everyone, we help ensure everyone is satisfied in the end, not just the patient or the hospital system.”
The Kaizen method promotes professional growth among staff, she adds. Project managers keep the teams focused, “but we want our staff to do the work so they can feel empowered and make the case for change.”
Eight Forms of Waste
In analyzing factors that affect job efficiency, one problem-solving exercise is to analyze the eight forms of waste with the acronym TIMWOODU:
- Travel: Is there unnecessary patient or material movement? Do you have patient transfer paperwork?
- Inventory: Do you have too many supplies? Too few?
- Motion: Do you waste time looking for misplaced forms, equipment, or charts?
- Waiting: Are you always waiting for lab results? Or waiting for the doctor to write a discharge order?
- Overproduction: Are you printing reams of paper? Is there a better way to share the information?
- Overprocessing: Are you completing too many forms with the same information?
- Defect: Are you encountering too many entry errors?
- Underuse of human talent: Is the right person performing the job? Is this really a task for a nurse case manager, or can another staff person handle it?
A simple problem-solving technique helps get to root of problems is asking “why?” at every point. When those answers are mapped, your solution becomes clear, says Hooven.
Hooven suggests bringing the project team together every one or two weeks to review the progress. Illustrating the progress via a process map or sticky notes helps the team visualize where they are in the process.
“This process will show when you were able to complete part of project so you can celebrate it, and everyone feels good about it,” she says. “This empowers the staff, keeps them engaged and motivated so they will keep working toward change. We’re holding that carrot, giving them motivation.”
The team also is encouraged to create an elevator speech about the project. “This helps them find their voice so they can make the case for change, and for sustaining change,” she explains. “It’s important that we emphasize the need to continue the change after reaching our goal.”
Some projects can be completed in a couple weeks — the easy fixes, Hooven says. A larger project will take months. She advises working on a short-term goal while the larger project is in process. “This allows the team to see results, which provides motivation to keep with the bigger project.”
One recent project: to reduce hours a patient is held in observation. “We don’t want patients in observation status over 18 hours, or we lose money,” explains Hooven. “In the end, we decreased observation by several hours in each case.”
For this project, they implemented a few techniques to decrease observation patients’ hours in the unit, says Colleen Royer, RN, MSN, CCN, senior director of care management nursing at Cleveland Clinic Foundation.
“We implemented a visual board, which showed actual hours in observation so that the team could all be alerted to the importance of time,” Royer adds. Also, they developed a gatekeeper for the observation unit — a nurse practitioner to facilitate orders and results faster. To sustain their efforts, they posted data every three months for the team to see their progress and celebrate results.
Their next short-term project will be to reduce avoidable delays in patient discharge. What is holding up the discharge? The consulting physician? Precertification for admission to a skilled facility? These avoidable delays are costs that add up.
The team will document and evaluate these avoidable delays to determine a process for correcting the situation. Hooven expects the process to take just two weeks.
The next big hospitalwide project will focus on timely patient discharge. The team will work to ensure doctors, nurses, and case managers are communicating consistently to prepare patients for discharge.
It is all based on preparing discharge orders quickly. Putting in place all the key components for discharge is vital. “The nurse, case manager, and social worker must be proactive in getting all factors ready,” says Hooven. “If the patient needs antibiotics to take home, we will make sure there’s a prescription ready. Otherwise, discharge is not going to happen.”
Everyone doing their job more efficiently is the goal, she explains. “The patient will be happy because they’re ready to move on and won’t be delayed. The hospital system will be happy because they’re utilizing beds more efficiently and helping patients go home sooner,” says Hooven.
Also important, “the staff will be happy because they get to go home on time,” she adds. “In our analysis of the process, we had to recognize staff unhappiness with late discharges. No one wants to work late, not get home until 6 p.m., time after time, they get burned out. Our goal is to make the process more efficient to increase caregiver satisfaction as well.”
Efficiency and cost savings are worthy goals. Satisfaction also is relevant, whether applied to patients, frontline staff, managers, or chief executive officers. If your hospital workday is inefficient, satisfaction suffers at all levels. That is where the Kaizen method can help.
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