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5S-KAIZEN-TQM Approach in Hospitals

5S-KAIZEN-TQM Approach in Hospitals. World Business Associates Co. Ltd., Japan Director & Senior Consultant Jun SUGIURA. Lecturer self-introduction. Jun SUGIURA. Occupations: - Director & Senior Consultant, World Business Associates Co., Ltd., Japan

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5S-KAIZEN-TQM Approach in Hospitals

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  1. 5S-KAIZEN-TQM Approachin Hospitals World Business Associates Co. Ltd., Japan Director & Senior Consultant Jun SUGIURA

  2. Lecturer self-introduction Jun SUGIURA Occupations: - Director & Senior Consultant, World Business Associates Co., Ltd., Japan - Management Consultant Registered by Minister of Economy, Technology, & Industry , Japan - Management Advisor, Small and Medium Enterprise Support, Japan - Expert Consultant, registered by Tokyo Federation of Societies of Commerce and Industry, Japan - Member of Japan Small and Medium Enterprise Management Consultants Association Background: Graduated from BE and ME of the University of Tokyo in 1975 and In 1978, respectively From 1978 to 2003, Hitachi, Ltd.. (semiconductor business Div.) Occupied Director of Technology Development, Director of Designing Division, and General Manager of Technology, successively From 2003 to 2009, Renesas technology Corp. Occupied General Manager of Business Development Div. and Executive of Planning Div., and Board Director of two design subsidiaries

  3. World Business Associates Co., Ltd., Japan World Business Associates Co., Ltd.(WBA) was established in April 2006, as a professional group for SME promotion, which is consisted of over 100 members including 70 affiliated consultants and 35 network members (as of January 2013), we possess a great deal of experience and expertise for the purpose of SME promotion/ support, human resource development, researches/studies and etc. both in domestic and overseas. Our business characteristics are not only providing with partial Kaizen (improvement) and level-up, but also to practice consultant and assistance services which are based on SANGENSHUGI (The Three Actuals -Actual Place, Actual Thing, and Actual Situation) through the general management, making use of advantages of SME Management Consultants. A special feature of our company’s business activity is that the project partnership and commissioned business are advanced with various international organizations including Japan International Cooperation Agency (JICA) and Japan Cooperation Center for the Middle East (JCCME). We also pursue extensive partnership with many SME promotion organizations such as The Organization for Small & Medium Enterprises and Regional Innovation, JAPAN (SME Support, JAPAN), Japan Small and Medium Enterprise Management Consultant Association (J-SMECA), and The Tokyo Chamber of Commerce and Industry (TCCI).

  4. Table of Contents 1. Origin of “the 5S-KAIZEN-TQM” 1.1. History 1.2. Background Concepts 1.3. Present conditions of “the 5S-KAIZEN” in Japan 1.4. Why is it difficult to sustain? 1.5. The way of sustaining KAIZEN 2. How “the 5S-KAIZEN-TQM” spread into hospitals 2.1. Purpose of introducing them 2.2. Procedure of introduction (Key factors of success) 2.3. Present activities in Japanese and the US hospitals 3. JICA (Japan International Cooperation Agency) ‘s approach 3.1. “Clean Hospital Program” in Africa 3.2. Logic Model of “the 5S-KAIZEN-TQM” approach 3.3. Present conditions at African hospitals 4. Conclusion Appendix 1. Contents of KAIZEN Appendix 2. KAIZEN PDCA -Continuous Spiral of Improvement -

  5. 1. Origin of “the 5S-KAIZEN-TQM”

  6. 1. What is KAIZEN? -Continuous Improvement - 改　善 KAI ZEN Change For the better Meaning of words: Continuous Improvement True meaning:

  7. 1.1. History: Industry W. Edwards Deming (U.S.) (Statistician) Quality Control 1950 TQC KAIZEN/5S TQM KAIZEN/5S KAIZEN/5S (QC Circle) Japanese Auto Industry Electrical Industry TQM TQC KAIZEN Not same 1980’s TQC 1960’s TQC 6 sigma TQM U.S. Electrical Industry TQM

  8. 1.1. History: Hospital Hospitals In Sli Lanka Hospitals In Africa Industries In Sli Lanka Asia/ Africa Knowledge Co-creation Program (JICA) Hospitals In Japan Industries In Japan 5S-KAIZEN Industries In the U.S. Hospitals In the U.S. TQM

  9. 1.1. History: Hospital in Iran Hospitals in Iran Hospitals in Europe Industries in Iran ? ? ? Hospitals in Japan Industries in Japan 5S-KAIZEN Industries in the U.S. Hospitals in the U.S. TQM

  10. 1.2. Background Concepts: Purpose of KAIZEN (Private Hospital) Continuation of Hospital Profits Patient Satisfaction Investor Satisfaction Investment Products (Service) Materials Machines People Education Motivation KAIZEN

  11. 1.2. Background Concepts: KAIZEN is far more than a waste-reduction methodology. KAIZEN is a system of philosophy, processes, people, and problem solving that is striving for excellence. (by Jeffrey K. Liker) Mechanistic Organization （Machine Thinking) Organic Organization (System Thinking)

  12. 1.2. Background Concepts:

  13. 1.2. Background Concepts: Work Groups know problems/issues in work site. Work Groups know feasibility of countermeasures of them. Japanese TQM Western TQM Work Groups Executives Middle Managers Middle Managers Top Down Bottom Up Executives Work Groups

  14. 1.2. Background Concepts: Whose responsibility is job improvement? Vision of department Target of department Method Show direction 3 Roles of Middle Manager Give incentive Persuade members Praise Recognize Respect Communication Follow up Coaching

  15. 1.2. Background Concepts: What are executive’s roles? Company philosophy Goal of improvement Show Philosophy 3 Roles of Executive Strong commitment Show examples by top executive Manpower Resource Investment Execute improvement Attend meetings

  16. 1.2. Background Concepts: What does bottom up mean? (work group roles) • Recognize gap between present status and goal, xxxxxxxxx. • Find problems/issues which disturb filling gap, xxxxxxxxx. • Analyze root cause of the problems/issues, xxxxxxxxx. • Propose feasible countermeasures of the root cause, xxxxxxxxx. • Make execute plan of the countermeasures, xxxxxxxxx. • Do execute plan, xxxxxxxxx. • Check the result of countermeasures, xxxxxxxxx. This process is PDCA cycle. (KAIZEN)

  17. 1.2. Background Concepts: Question 1. Who should decide the target(Goal)? Question 2. What word is appropriate for xxxxxxxxx. independently or voluntary?

  18. 1.2. Background Concepts: • KAIZEN is continuous improvement spiral. ( Endless PDCA improvement cycle) Each PDCA cycle may not one cycle.

  19. 1.2. Background Concepts: KAIZEN/5S is one of the tools to improve quality. Maximum Profit Customer Satisfaction Total Quality Management Guarantee of quality Quality Control KAIZEN 5S

  20. 1.3. Present conditions of “the 5S-KAIZEN” in Japan Millions of companies / organizations have introduced KAIZEN. But how many companies still maintain continuous improvement? Service (3%) Other manufacturing Industry (9%) Steel industry (7%) Electric Apparatus (15%) 1,209 companies Transportation equipment (43%) Companies registered to Union of Japanese Scientists and Engineers (August 2013)

  21. 1.3. Present conditions of “the 5S-KAIZEN” in Japan Number of public companies in Japan is about 2million. Therefore registered 1,209 companies are only 0.06%. A few 5S (Five S’s) / KAIZEN is easy to start because it is simple and requires less investment. But it is difficult to continue active.

  22. 1.4. Why is it difficult to sustain?: Question 3. How many companies/organizations have introduced 5S? Question 4. How many companies which have introduced 5S are still sustaining it with satisfactory level?

  23. 1.4. Why is it difficult to sustain?: Every activities may reach to be saturation (inactive), if you do not doany effort to sustain. Mannerism Formalism High Plateau Performance Decline Growth & Expand Introductory Low Time

  24. 1.4. Why is it difficult to sustain?: Question 5. Have you ever taught the Ultimate Purpose of KAIZEN to your group members? Question 6. Have you ever asked consultants to provide the examples of KAIZEN as many as possible?

  25. 1.4. Why is it difficult to sustain?: If the answer of Q5 is “No”, and the answer of Q6 is “Yes”, You misunderstand KAIZEN/5S. You are lucky to be here!

  26. 1.4. Why is it difficult to sustain?: 5S-Sort Set-in Order Shine Standardize TOYOTA’s 4P Model Problem Solving (Continuous Improvement) 5S-Sustain People & Partners (Respect, Challenge, Educate) KAIZEN Process (Eliminate Waste) Ultimate Purpose Philosophy (Long-Term Thinking)

  27. 1.4. Why is it difficult to sustain?: • Five why (5W) analysis of why KAIZEN/5S aren’t sustained. Countermeasure. The top executives should learn KAIZEN/5S properly and should be committed leaders to long term mission.

  28. 1.5. The Way of Sustaining KAIZEN 1. Top managements continuously show; Philosophy, Strong commitment, and Interest. (Consistency of direction) 2. Activity must keep the background concepts. (Bottom up voluntary activity) 3. Develop internal KAIZEN coaches. (People Development) 4. Keep continuous checking and adjusting. (KAIZEN PDCA)

  29. 1.5. The Way of Sustaining KAIZEN Highly Developed Work Groups Middle Managers as Coaches Continuous Checking and Adjusting Consistency of Direction Executives as Visionaries And Guides Rock-Solid Culture of Continuous Improvement: Skills and Commitment

  30. 1.5. The Way of Sustaining KAIZEN With Philosophy & Background Concepts High Performance Plateau Without Philosophy & Background Concepts Decline Growth & Expand Introductory Low Time

  31. 2. How “the 5S-KAIZEN-TQM” spread into hospitals A part of the contents of this chapter reprints them from the following report of JICA. Thematic Evaluation "Analysis of the Outcome Generating Process of 5S-KAIZEN-TQM Approach in Hospitals" (Final Report): http://www.jica.go.jp/english/our_work/evaluation/tech_and_grant/program/thematic/

  32. 2.1. Purpose of introducing KAIZEN: GDP ratio of medical expenses These ratio remarkably increased both in Japan and the U.S.. (%) (%) 17.7 12.4 9.6 5.8 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 Year Year OECD-Health-Statistics 2013

  33. 2.1. Purpose of introducing KAIZEN: Medical insurance system In Japan, people tends to go to the hospital which serves better quality and better service

  34. 2.1. Purpose of introducing KAIZEN: Profit and loss of hospitals in Japan Most of Japanese hospitals seem to have big problems in efficiencies. 2007 Ministry of Health, Labour and Welfare, Japan

  35. 2.1. Purpose of introducing them: The number of law suits by medical accident drastically increased in Japan Number of law suits 2000 2005 2008 1992 1995 Year Supreme Court of Japan

  36. 2.1. Purpose of introducing KAIZEN: The purposes in both countries are similar. In Japan, the purposes of introducing KAIZEN are; 1. Improve financial balance (Prevent bankrupcy) 2. Improve patient satisfaction (Increase income) 3. Decrease medical accidents (Reduce claims) In the U.S., the purposes of introducing KAIZEN are; 1. Reduce medical cost (Demand by insurance company) 2. Decrease medical accidents (Reduce claims) 3. Improve patient satisfaction (Increase income)

  37. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Analyzing Structure of KAIZEN Introduction (Japan, The US, and Sri Lanka) Higher Concept (Impact) Indicators Condition To express Outcome Outcome Indicators Process Measures To overcome Bottleneck Bottleneck

  38. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Higher Concept

  39. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Higher Concept • Japan and the USA: • Improvement of hospital management • Reduce cost and increase profit • Reduce extra settlement money by eradicating medical • accidents and reducing hospital infections • Increase the number of patients by improving service • for patients through improved work efficiency • Sri Lanka:(National hospital) • Reduction of hospital infections

  40. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Outcome

  41. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Outcome(continue)

  42. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Outcome • Japan and the USA: • Reduce cost • Positive attitude of staffs • Sense of solidarity • Patient satisfaction • Sri Lanka:(National hospital) • Reduction of Rate of infection • Reduction of stillbirth rate • Reduction of death • Positive attitude of staffs • Sense of solidarity

  43. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Condition for expressing outcome

  44. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Condition for expressing outcome (continue)

  45. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Condition for express outcomes • Japan, the USA, and Sri Lanka: • Leadership of top management • Conduct training for understanding concepts and basic • methodologies as early as possible • Participation of staff in all divisions • Japan: • Voluntary activities • The USA: • perceive quality in a broader view

  46. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Process

  47. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Process • Japan and the USA : • Set purposes and goals • Use PDCA cycle • Share know-how at activity presentation • Sri Lanka : • startactivity on a small scale and expand it all divisions • in the end

  48. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Bottleneck

  49. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Bottleneck(continue)

  50. 2.2. Procedure of introducing KAIZEN: (Key factors of success) Bottleneck • Japan and the USA : • Existence of resistant • Participation of doctors • Walls among divisions • Burdens on staffs • Sri Lanka : • Existence of resistant • Fund for activities

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