Three leaders from the International Consortium for Health Outcomes Measurement (ICHOM) – a nonprofit founded by organizations known for progressive business practices and rigorous research: Harvard Business School, The Boston Consulting Group and the Karolinska Institutet – published an article in Harvard Business Review that analyzes the success some healthcare organizations have had in implementing patient outcomes measurement programs. The article lists five steps that should be applied when implementing major change or process improvement within healthcare systems. This blog post is the second in a series of five that builds upon each ICHOM step from a Kaizen perspective.
The Necessary Roles of a Cross-Functional Team
The second imperative outlined by the ICHOM is the formation and organization of a cross-functional team that can drive a multidisciplinary implementation process. We find that a Kaizen is optimal for building a cross-functional team capable of rallying around tangible improvements to a value delivery stream.
To ensure accountability each Kaizen begins by bringing together stakeholders and process champions that are responsible for the business objectives of the organization. These executives oversee every component of a particular workflow and are therefore best suited to choose Kaizen topics and assign team members who can contribute effectively.
We have identified a standard team makeup that gives us the best chance for success. The specific roles within the Kaizen Team include the Team Leader, the Co-leader, the Facilitator, the Subject Matter Experts and the “Fresh Eyes.” For every Sheridan Kaizen event, we mandate that the newly formed team directly observe a workflow before they begin to analyze and discuss opportunities. Ultimately, an ideal Kaizen Team strengthens the process by bridging a multitude of perspectives that would otherwise exist in silos and ensures organizational buy-in through its broad participation.
Champions and Leaders
In the first part of the process improvement blog series, we discussed the need for a broad base of believers and the formation of a particular believer into a Champion of that change. The person of foremost importance in the formation of a Kaizen topic and team is the Champion. A Champion selects the topic under review and is ultimately responsible for the Kaizen Team’s outcome. It is the responsibility of the Champion to both ask questions and vet the conclusions of the Kaizen Team members. The Champion must be inquisitive and assertive, asking questions that get to the heart of the matter and giving the team approval to pursue their desired ideas for improvement.
Although the Champion drives the direction of the Kaizen event, it is the responsibility of the Team Leader to act as a marshal throughout the event. The Leader comes from a leadership position within the service line (e.g., anesthesiology, radiology), but not within the department undergoing the event. Frequently, we invite a leader from another facility. The Leader must be neutral, unbiased and fair in their arbitration of the discussion. It is their responsibility to ensure that every voice is heard and considered. Frequently, a potential future Chief of Medicine or other rising star within the site will be invited to shadow the Leader as a Coleader.
It is the job of the Facilitator to assure that the Kaizen Team follows a consistent agenda. Facilitators do not contribute directly to the content being discussed; rather they formalize and regulate the discussion and team on tools and principles that enable to team to develop expert ideas with minimal training. The best Facilitators interact exclusively with the Leader to teach him or her how to keep the discussion on track. In this sense, the Facilitator elevates and enables the leader to direct the discussion in the most effective way possible.
Expert Insiders and Total Outsiders
It is necessary to invite a Subject Matter Expert (SME) to the event in order to comment on the workflow. The SME provides a deeper level of insight by elaborating on the facets of the workflow being discussed. By sharing expertise with the Kaizen Team, the SME is able to clarify and nuance the workflow’s mechanics thereby enabling others to comprehend the challenges and opportunities for process improvement.
The SME provides invaluable knowledge to the Kaizen Team, however it also behooves the team to include someone who is a total departmental outsider. The “Fresh Eyes” are included to question everything and to bring to light problems within the workflow that are otherwise taken for granted.
A powerful example of the need for fresh perspectives comes from the interventional radiology (IR) department at Jupiter Medical Center in Florida. The Fresh Eyes expressed concerns previously unconsidered by the rest of the team regarding the positioning of imaging screens in consultation rooms. Jupiter’s IR team had previously not considered that the rooms were designed such that many patients were unable to see the screens. The Kaizen Team thereby redesigned the consultation rooms to improve accessibility, which elevated the overall quality of patient care. By bringing an outside perspective to the discussion, the Fresh Eyes are able to provide a complimentary role to an SME to broaden the discourse. Together the SME and the Fresh Eyes are able to provide greater understanding of the intricacies of the evaluated process and the bigger picture of quality patient care.
As our last blog post in the series stressed, although the Kaizen event is a moment to ignite substantive change, the Kaizen philosophy of improvement extends beyond that. Visual Management on a daily basis is a vital component of implementation and follow up. After the event concludes it is necessary for the Champion to report out to other organizational leaders in order to determine the rate of progress and the effectiveness of the changes made. Open and visual communication enables the organization’s leadership to adjust, compensate and suggest further changes in order to optimize process improvement. In this sense, the Kaizen event kicks off a deep dive that sparks improvement and enables the organization to implement meaningful change. It also ensures a common language and goals among the leadership team. In our view this is the best use for a cross-functional team, empowering employees from all walks of the organization towards meaningful and tangible change.