Redesigning Clinical Workflows to Return Joy to Patient Care
Going to Gemba – “It Hurts So Good”

I was recently coaching a VP of a medical group in a large academic health system. One of her roles is executive sponsor for a value stream named “Provider Onboardng.” She was pleasantly surprised that the steering team meetings for this value stream are the most well attended of any of the five active value streams in this organization.

patient-in-EDThis was particularly gratifying because many of the team members are from support departments that are not known to be as helpful to other value streams’ requests for help.

As we talked more to figure out why this is, the most likely cause seemed to be that each team member personally feels the pain of the dysfunction in the work of onboarding providers. The flow in this value stream is the hiring of doctors, starting from the decision in a department that a new provider is needed through to the point where that provider is able to see patients and bill for services.

The team members come from departments like credentialing, compliance, IT, and clinic operations.

One of the challenges in this value stream is identifying a gemba to go to in order to see the work. Most of the work is processing an application, and is done by one person on a computer, who then sends it on to another person in a different department who is working on another computer.

We realized that the people on the steering team ARE the gemba, feel the pain directly and personally, and are highly motivated to improve the work flow!

What does this tell us about:

  • Why should we to gemba?
  • How should we go to gemba?
  • Why is going to gemba such an important part of leader standard work?

Why go to gemba? We go to gemba to see the actual work being done. In doing so, we can see the waste and feel the pain of the caregivers and patients. We can’t get this by reading reports or attending staff meetings. When we see and feel the pain, we are motivated more strongly to support the caregivers on the front lines.

Surgical-Team-KneeHow do we go to gemba? We go with respect for the people doing the work and with a goal of simply observing the work to in order to understand the challenges of the workers. We let them know ahead of time so they don’t wonder why a leader that they rarely see is suddenly coming around. We thank them for their good work, and for allowing us to observe.Surgical Team Knee

Why is this important? Going to gemba like this does a number of things:

  • When we see the pain, unfiltered by reports from others, our commitment to our lean journey grows stronger, and our urgency to support change more quickly and effectively increases.
  • We learn things that we otherwise would not know, things that can make a dramatic difference.
    • Dr. John Toussaint talks about his experience going to gemba in the ICU and realizing how poorly designed it was for the work the nurses were doing, resulting in redirecting a major capital building project.
    • John and I coach another CEO who we took to a pediatric ward, where he saw nurses coping with poorly designed patient rooms and nurses stations, resulting in him rethinking a request from the medical staff to upgrade the facility.
  • You simply can’t get this experience any other way. Being with the people is key to respect for people.

My personal passion for Lean comes from having been embedded in the gemba during my 25 years of family practice with over 100,000 patient interactions. While there was a lot of joy in caring for patients, there was a lot of pain due to the broken processes in my clinical sites.

What about you?

Do you find it hard to go to gemba?

Is going to gemba a part of your standard work?

What have you learned, or how have you changed, as a result of going to the gemba? Does it “Hurt So Good?”

Please reply below to share your thoughts on this.

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