Published by: Lindsey Roth on 12/3/2010 10:16:45 AM
During the week of October 25, I had the opportunity to visit Contra Costa Health Services in Martinez, CA, to observe a week-long “Kaizen” quality improvement event focusing on perinatal care. The Kaizen method, derived from Japanese management concepts, means change (“Kai”) to become good (“Zen”).[1] Above all, the Kaizen method focuses on helping employees learn to spot and eliminate waste in business processes.[2] Over the past year, Contra Costa has adopted the Kaizen method to support them in improving key service lines, including psychiatric care programs and perinatal care. While attending this event, I learned how Contra Costa is using Kaizen to identify waste and strategies for improvement in perinatal care. I also came away with observations about the value of this type of work for safety net hospitals.
Two consultants facilitated the week-long Kaizen event on perinatal care, and more than 20 Contra Costa employees participated, including the department chair, physicians, residents, nurses, social workers, housekeeping, administrative, and quality improvement staff. The event included staff from Contra Costa’s Healthy Start (a perinatal program for low-income, high-risk, and/or culturally diverse pregnant women and new mothers ), pre- and post-natal clinics, and the inpatient labor and delivery unit. The group also welcomed a patient who had recently delivered a baby at Contra Costa to take part in the Kaizen experience.
The Kaizen team spent the first day of the week identifying each component of the patient experience, from the first prenatal visit through the first well-baby checkup. The team highlighted the following stages of care for further analysis:
1. Healthy Start intake
2. Prenatal visit
3. Antepartum testing
4. Triage
5. Labor and delivery
6. C-Section
7. Postpartum inpatient (including discharge)
8. Clinic postpartum visit
They then broke into eight smaller groups, each focused on a specific stage of care, and spent two full days observing patients and staff as they went through various processes within the stages. The participants conducted “value-stream mapping,” in which they calculated value-added and non-value-added time spent by both staff and patients during each process. On the fourth day, the Kaizen participants reconvened to report their findings, focusing on the value-added time they observed for patients and staff. The group discussed and proposed strategies both to increase value-added time and patient-centeredness and to reduce wasted time. Participants summarized their strategies into a one-page proposed plan, which included their problem statement, target, problem analysis, proposed actions, and action items. On the final day, the team presented its proposed plan at a forum held in the hospital lobby, open to any hospital employee or community member wishing to attend.
Upon observing the fourth and fifth day of the week-long Kaizen event, I was struck by how much time and effort Contra Costa’s leadership and staff dedicated to it. More than 20 employees devoted a full work week to the Kaizen event, which required them either to arrange for other staff to cover their regular duties or to attend to their regular duties after hours. I also was struck by how welcoming and accommodating the patients and staff were to the Kaizen team who shadowed them
During the group discussions, I found there to be an atmosphere of openness and easy flowing communication, which I thought was augmented by having a patient member of the team available to provide key insights; without patient participation in the Kaizen event, that critical perspective would have been absent. This transparency was also evident on the final day, when the team presentation to other Contra Costa staff and the public included frank discussion on current issues and proposed solutions. Ultimately, I was extremely impressed that, post-health reform, Contra Costa is preparing for the changing environment by proactively making their care more patient-centered. It is not only the “right” thing to do, but as competition increases between hospitals, these types of reforms will help keep safety net hospitals in business by retaining and attracting patients.
While the group I observed produced an enormous amount of work in a short amount of time, the hard part is just beginning for them. Over the next year, they will conduct smaller Kaizen events for each of the stages of care mentioned above, and continuously use plan-do-check-act (PDCA) cycles to test out the proposed strategies. Although they may see a long road ahead of them, I was very grateful to be included at the beginning of their journey to “change to become good,” and look forward to seeing them achieve their ambitious goals.
1 http://www.valuebasedmanagement.net/methods_kaizen.html
2 http://www.epa.gov/lean/thinking/kaizen.htm