VALUE IMPROVEMENT LEADERS

TOPIC #8

520 words + 2 activities | 37 minutes (2 read, 5 watch video, 30 plan a gemba walk)

GEMBA

PRINCIPLE The easiest way to understand a process is to go see it. Ask the process experts about it. Show respect for them and their work.  APPLICATION 1. Watch the gemba video  2. Plan a gemba visit

Gemba: Where the Work Happens I don’t have your value summary in front of me so I don’t know the problem you’re trying to solve. I do know the problem originates in a process which takes place in a place . That place is called the gemba (Japanese: the real place).

Think Like a Detective The first actions of every self-respecting detective: Go to the scene of the crime, search for clues and interview witnesses. Let’s drop that analogy right there; you’re NOT investigating a crime. You’re investigating a process with an opportunity to improve an outcome. You’re going to talk to conscientious colleagues doing their best within a process designed for them.  The purpose of going to the gemba is to understand the process. You can’t see the process nor its challenges from a conference room. Data and quantitative analyses are vital to value improvement but neither are a substitute for eyes directly on the work as it happens.  Let’s say you’re a physician investigating catheter-associated urinary tract infections. Clearly you’ve been to a patient room before. But have you shadowed the HCA during a catheter placement or peri-care? Have you asked the HCA to explain what’s happening as it happens and why it’s done that way?  There are lots of excuses to skip this simple and important activity, but if skip it, you haven’t seen the process, not the real process in the real place.

Go See. Ask Why. Show Respect. The above headline is a general plan. Notice it doesn’t say: Give advice. Craft solutions. Correct the actions of the process owners.  Go see. Watch for the seven wastes and safety risks. Note steps that surprise you. Ask for a copy of the forms and materials used. Take pictures where HIPAA allows (pro tip: never of a patient or patient information).  Ask why. Talk with those performing the work. They have valuable information that their boss does not. Ask the owner to explain what’s happening and why. Questions like ‘Why in that sequence? Why for that duration? Why that supply?’ Show respect. These are not quiz questions. Let your genuine curiosity and desire to improve be your guide. Listen intently and show respect as you would to a teacher - you are the student in this exchange.  Before you go, take a moment to make a more specific plan.  What specifically do you want to learn?  What steps do you want to focus on?  What questions do you already know you want to ask?  Your plan doesn’t have to be any more complicated than that. Importantly, always leave room in your plan for the unexpected.

Every Process Has a Gemba A gemba walk, as described above, is vital for discrete value improvement projects. It is integral to continuous improvement. Here’s a video (4:45) about going to the gemba including a story about Dr. Mark Eliason’s gemba walk to a call center.

ACTIVITIES 1. Watch the gemba video (4:45) 2. Plan a gemba walk (possibly with your coach)

LINKS Quickly locate all course videos, slides, and previous emails here .

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Accelerate | University of Utah | healthsciences.utah.edu/accelerate Questions? Email:  kim.mahoney@hsc.utah.edu

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