Jupiter Medical Center: The when and how to use Kaizen in healthcare

With hospitals feeling the pressure to improve efficiency and lower costs, some are implementing the Kaizen method to streamline processes. Kaizen is among a number of process improvement strategies taking hold at hospitals across the country, including Six Sigma and lean. They all aim to improve existing processes within a hospital, but they're not one in the same.

So we turned to a hospital that gained experience with Kaizen, Jupiter (Fla.) Medical Center. Lee Fox (pictured right), M.D., Sheridan Healthcare's chief of radiology at the medical center, has been in the kaizen trenches and offered some insights on how to facilitate process improvements.

FierceHealthcare: Can you share some examples of how Jupiter Medical Center applied Kaizen to improve quality and lower costs?

Lee Fox: Jupiter Medical Center has engaged in nine different Kaizen initiatives to date. Some examples of improved quality and lower costs include, but are not limited to, increased patient satisfaction scores focused on wait times. Our patient wait times in the holding area were reduced by 50 percent.

The wait times at the breast center for a patient checking were reduced by 30 minutes as well, which has had a positive effect on patient satisfaction as measured by our Health Stream data measurement scores.

We also implemented an on-call policy with specific criteria. This initiative is driving down our salary expenses on a monthly basis in most modalities.

Renovations and spaghetti models helped us evaluate staffing ratios and logistical improvements. This led to changes that reduced expenses and other changes that enhanced revenue.

FH: What role does leadership play in Kaizen improvement efforts?

Fox: Culture is intangible but very powerful, and the leader has the most impact. Leadership's role, with the guidance of our Kaizen consultants, was to identify cultural barriers that were preventing change from taking place. Once we created a vision statement, and articulated an envisioned future from an enhanced performance perspective, as well perspectives on competency and culture, team members were able to buy in to the change process and take ownership of making change happen.

FH: What is the secret to successfully implementing the Kaizen method?

Fox: The secret is to let the team members feel empowered to make the changes for process improvement. The Kaizen events provided a structure to channel the opportunities for improvement detected by the individual team members in the group and convert them into realized changes that have a positive impact in the way people perform and perceive their work.

FH: What savings did Jupiter achieve from Kaizen initiatives?

Fox: After a Kaizen event, it takes leadership and a team effort to effectively manage the change process. Currently, we are in the process of measuring our total expense reductions for the rest of the fiscal year, and many of the savings initiatives were derived from Kaizen events.

The radiology team actively participates in cost savings challenges. The team is a big part of achieving expense reduction goals and many of them are tied to their team member performance goals for merit increases. These team driven activities to reduce expenses would not have been possible prior to Kaizen events.

FH: How does Jupiter Medical Center measure and report progress of Kaizen initiatives?

Fox: Jupiter has very specific data points that we measure on a monthly basis to track our progress. The report card is displayed for the team to see and review. The management team reviews the metrics with the team at each departmental meeting. This is important because it allows the team to see that their efforts had a positive impact on the organization. It keeps the spirit of Kaizen alive, and the feeling that they were part of making a change for the better.

FH: How did Jupiter gain employee participation and buy-in at all levels?

Fox: The partnership between Sheridan Healthcare, Jupiter Imaging Associates and Jupiter Medical Center was a key factor in getting the team to buy in to the program. The team saw value in participating, knowing that having a cohesive relationship with the radiologists was a critical success factor for workflows to improve.

In addition, education and communication to the team regarding the Kaizen concept event were delivered with enthusiasm. Sherri Lewman, director of radiology, and I presented it as a way to "make things better" for them.

The senior leadership team at JMC was supportive and appreciative that the radiology department was taking the forward thinking initiative to improve processes and gain efficiencies. They saw it as a value-add for the organization. As a result, the radiology department was viewed as a leader in process improvement. It was contagious and the rest of the organization wanted to participate and learn what Kaizen offers.

FH: What is the difference between Kaizen, Six Sigma and Lean--and when should hospitals use each method?

Fox: The benefits of Kaizen include the participation of all collaborators in improving and transforming the organization in small, every day, incremental steps that do not lose effectiveness over time. Some of the elements utilized to support Kaizen are visual management Kaizen boards, a Kaizen proposal format, a proposal scoring matrix, a Kaizen rewards system and monthly metrics reporting.

Besides the tangible benefits, Kaizen is regarded as the most effective technique to improve engagement and culture within a company.

Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of errors and minimizing variability in manufacturing and business processes. It uses a set of quality management methods, and creates a special infrastructure of people within the organization.

Lean improvements result from elimination of waste during the process. Waste may be defined as extra steps that can be eliminated while still achieving the same end result, or the reduction of idle time during the process, and you need to look at ways to continually improve the process in less time and at a lower cost.

Hospitals should choose the best method for them.

FH: What is the most important thing a hospital leader should know about implementing the Kaizen method?

Fox: In a lean healthcare environment, leaders must be taught how to facilitate improvements while avoiding the temptation to jump to conclusions and offer what they think is the right solution. By avoiding that temptation, it becomes possible to focus on identifying the real problem, the root cause, before prescribing a solution.

Simply ask questions when confronted with a problem.  By asking the right set of questions, the leaders are engaging their staff in the lean process. This ensures the problem is completely understood by everyone and avoids a hasty and uninformed quick fix. Essentially, it allows the root cause of the problem to be identified.

Editor's note: This interview has been condensed and edited for clarity.

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