The art of being ‘Lean’: Why Ontario hospitals are ‘going to the gemba’

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 By Erica Di Maio

“Open your kimono”: To be honest, open and share your truth.

This is how Brenda Kenefick describes one of the defining principles of the Lean Learning Community, a dynamic group of professionals dedicated to fostering a strong learning culture and driving process and quality improvement within Ontario hospitals.

In 2015, Brenda, Director, Lean Process Improvement at the University Health Network (UHN), founded the Lean Learning Community. What began as a modest membership of five organizations, including UHN, Quinte Health Care, St. Thomas Elgin General Hospital, Mount Sinai Hospital and Sunnybrook Health Sciences Centre, has expanded to more than 20 member organizations in 2017.

“As a Community, we tackle the complex challenge of changing attitudes and building a culture of constant improvement – where people and teams begin to see problems as opportunities and feel compelled to make a change – big or small,” says Brenda.

“Our goal is to foster an open and honest dialogue around mutual challenges, issues and share best practices we can take back to our teams.”

The Lean Learning Community hosts three learning events per year – member organizations take turns hosting events at their respective sites, tackling different themes and high-impact process improvement initiatives. Key topics vary from safety, quality, delivery and efficiency, for example: finding safer and more efficient ways to complete tasks, improving the patient experience, reducing waste and stewarding hospital resources.

While event topics and locations change, one fundamental value remains the same: “going to the gemba.”

‘Going to the gemba’

“Going to the gemba”, a Japanese word meaning “the real place”, refers to the place where work is being done and value is created. From a Lean, hospital perspective, this signifies the importance of seeing a process firsthand, on the frontlines, to fully experience and gain insight on the problem at hand.

The Lean Learning Community, a travelling collective, plans its events around site visits, where the hosting member leads the group through a process improvement initiative and tour of selected areas; Community members have the opportunity to discuss change processes with frontline staff and consider how the work might be adopted and translated within their own organizations.

Stephen Bell, Manager, Process Improvement at Sinai Health System and member of the Lean Learning Community, emphasizes the important relationship between going to the gemba and value stream mapping, a method of analyzing current state to inform the design of a more efficient future state.

“Going to the gemba enables real action and propels transformation,” says Stephen.

“It’s always better to be present, with a well-informed understanding of where the work happens versus imagining what ‘might’ be happening from an office away from the work.”

“Stakeholders need to be aligned in their understanding of current state to identify the root cause of the problem. Only then can plans be made to map and shape what a sustainable future process looks like.”

One of the biggest challenges faced by many industries, including healthcare, is how to engage employees in a culture of continuous improvement, learning, and sustainability.

For Viviane Meehan, Lean Process Improvement Coordinator at Quinte Health Care, being a member of the Lean Learning Community has provided a network of like-minded individuals to discuss important topics like building capacity and engaging employees in process improvement work.

She explains the importance of building standard work so that regardless of ‘who’ is on the frontlines on any given day, quality and safe care is delivered consistently to patients. She’s learned that in order for true change to occur, staff must be engaged and at the forefront of the change process.

“Whenever change is required, it needs to happen ‘with staff’ not ‘to them’.  Part of the Lean philosophy is to shift our thinking from coming to work and ‘doing our jobs’ to coming to work and being responsible for how we can do our jobs better,” says Viviane.

One of the key indicators of process improvement success hinges on its ability to sustain itself.

“Once the process improvement team leaves the scene, how does that improvement sustain over time?” says Stephen.

“Ensuring owners of the process are educated and equipped to sustain the improvement through monitoring and measurement – and continuing to challenge the process over time – is part of sustaining a lean and learning culture.”

To join the Lean Learning Community or learn more, please contact Brenda Kenefick at askacoach@uhn.ca.

Erica Di Maio, Public Affairs and Communications, University Health Network