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Kaizen methodology means rapid changes
While the Kaizen methodology, developed by Toyota, involves examining processes in minute detail, it ironically can lead to rapid improvement in ED processes, says Sonya Carver, RN, clinical manager/days for the ED at Gaston Memorial Hospital in Gastonia, NC.
"In one instance, we had a one-day meeting and then did that work product immediately," she says.
Kaizen already had been adopted by the facility to be used for process improvement when the ED set out to improve its triage process, Carver says. "We looked at what was wasteful in our triage design — for example, serial processes as opposed to parallel processes — and developed the methodology that triage is a process and not a place," she explains. With Kaizen methodology, the focus is on the customer, which in an ED can be the staff or the patient, "so, it can be used to improve staff work flow so you work smarter and not harder," she explains. "If you can do more with less, like walking fewer steps to a piece of equipment, you eliminate waste and improve quality."
Carver was trained in Kaizen by the hospital's organizational improvement department. Kathleen Besson, RN, BSN, MBA, NEA, BC, director of emergency services, says, "You learn how to lead a group through a Kaizen event and also how to complete documentation so you can come out and have data — before and after, what you have gained — and actually put a dollar or time- saving figure to it. It's a very data-driven, deliberative process, and every project goes through the same steps."
The facilitator has to make sure he or she has the right people on the team, then assess the process, establish goals, work through each step, and see what the best opportunities for improvement are, Besson says. "When you come out of the meetings, you implement the changes fairly quickly. It doesn't take months or meetings regurgitating the same things over and over," Besson says. "At most, it's a two-meeting process."
Jodie Cook, RN, ED clinical manager/nights/weekends, who took the lead in staff education, says, "We educated the staff through staff meetings and e-mails, and informed them of the process and what everyone's responsibilities would be. We had a book in the CIA [the Care Initiation Area, one of the Kaizen solutions] describing the new process, and a place in the unit where staff could put suggestions and comments." In addition, she says, the leadership team would meet and debrief after each Monday and Tuesday to see how things were going. "We talked with the charge nurses to see what worked and what didn't," she notes.