Lean Daily Management and the Gemba Walk in Radiology

Every morning around 9:00 AM, the radiology staff and I take part in a process called Lean Daily Management (LDM) with hospital executives and directors of other hospital departments to improve operational efficiency. Lean Daily Management empowers employees at all levels to identify problems and solve them in a sustainable way. It is important to note that it is the front line staff who owns the process. It is the staff who identifies the issues, gather and assess the data, and decide on long-term solutions. LDM is not a punitive process, rather it is a mechanism that fosters a culture of collaboration and problem solving. It is the goal of LDM to create a safe, problem solving environment where barriers are systematically identified and brought to the attention of hospital leadership.

In radiology, as well as the other departments, a metric board called a gemba board is used by staff members to present their current data. The metrics typically fall under categories such as cost, quality, service, people, and safety.  A good metric should meet the following criteria.

• Metric is operational

• Metric has clearly defined occurrences

• Metric can be measured daily

• Data can easily be collected

Gemba is a Japanese term that loosely translates to “where the work takes place”.   Rather than solve problems in the conference room, management goes to the front line in the departments where the work takes place, thus the term “gemba walk”. The concept of the gemba walk was developed by Taiicho Ohno, an executive at Toyota. This methodology supports the concept that in order to better understand the issue, the work site must be visited to observe what is happening. It is then from the observations that solutions can be developed.[[{"type":"media","view_mode":"media_crop","fid":"31683","attributes":{"alt":"Jim Lipcamon","class":"media-image media-image-right","id":"media_crop_7685214735081","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3336","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 215px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Jim Lipcamon","typeof":"foaf:Image"}}]]

There are five golden rules of gemba management that summarize the activities of gemba walks:

1. When a problem arises, go to the gemba first. Do not hypothesize what is happening.

2. Assess the gembutsu, or relevant object.  For example, if a MRI machine breaks down, the MRI machine is the gembutsu.

3. Take temporary countermeasures on the spot.

4. Find the root cause. This can be often identified by asking, “Why?” Keep asking why until you drill down to the issue.

5. Standardize to prevent recurrence. Once the problem is solved, the solution needs to be standardized to facilitate a permanent solution.

Our radiology department is in the early stages of using LDM for identifying problems and developing solutions. There have been some wins in identifying issues and developing solutions. LDM is a process that takes time for the staff to get comfortable with particularly when presenting the information.

References

• Liebengood SM, Cooper M, Nagy P. Going to the Gemba: Identifying Opportunities for Improvement in Radiology.  Journal of the American College of Radiology/ 2013;10:977–979.