Streamlining Lab Processes: The Power of Kaizen

(bright music) - This is "Lab Medicine Rounds", a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, a transfusion medicine pathologist and assistant professor of laboratory medicine and pathology at Mayo Clinic. Today, we're rounding with Jessica Stellmaker, an instructor in laboratory medicine and pathology and supervisor of the Specimen Operations and Department of Laboratory Medicine and Pathology at Mayo Clinic.

And we're gonna be talking about Kaizen Events. Thanks for joining us today, Jessica. - Thanks for having me. - So for our audience out there,

some of them may be savvy to this event. I know when we were doing some initial planning, looking out there for what some great conversations would be, I actually didn't know what a Kaizen Event was. Can you kinda introduce this to our audience and then also maybe if you could kinda elaborate on why they're important for laboratories? - Yeah, absolutely, so a lot goes into Kaizen Events. I think starting with, what is a Kaizen Event? Is a pretty good question. So it encompasses a lot.

I'm gonna start with the people, 'cause our people are super important. They're the experts at the work that they do every day. And so what I think Kaizen Events allow us to do as a team, is bring all of those stakeholders together to really look at what that problem is and find ways to test things and reduce waste.

And so I always say Kaizen Events are good change, because it's change that you're making that you're going to test and make sure that it works before you just go in and implement something because you have an idea. And so during that Kaizen Event Week, you're gonna be doing lots of PDSAs, testing a lot of different ideas out, using data, obviously, seeing what works better for the process and flow and how do you reduce waste.

I think that's probably one of the biggest things too, is teaching people along the way, all of the waste that exists in all of our processes. And then giving them the tools and the resources to then reduce that waste and have the time to really focus on it and have a chance to look at things differently and then try different things and find what really is helpful to those processes. It is all about processes.

We try to take the focus off people, 'cause our people are gonna be successful if our processes are good. And so that's kinda the focus. How do we make better processes? How do we reduce waste? How do we get our people involved, the ones doing the work? So that they can test and see, it really adds the buy-in to it, right? We talk about change management, change management's built right into Kaizen Events, 'cause you have the people there.

The communication, the links between everybody within, you know, the stakeholders. And it's just a really good way of bringing about fast change too. I know sometimes when you go into projects, they can last and last and last, and a year later, you maybe made a change, and then we kinda forgot what the problem was. And so you can get a lot done in that week of rapid testing. - So I'm hearing you, if I can paraphrase it for the audience. And let me know if I'm getting this right.

It's sounds like... 'Cause I'm hearing a lot of the same language that I hear in some of the thing, like you brought up PDSA, the Plan-Do-Study-Act cycles that we might go through. You talking about bringing in all the stakeholders to the process. You talk about the importance of communication, the reduction of waste. A lot of those I think that some of our audience may be familiar with as far as topics within quality improvement or tactics, strategies on how to navigate it. - I love that.

- [Justin] Oh. - Yeah, I love that. - Is this a overarching,

like let's bring all these components together and how do we bring that all to bear? - Yes, I love it. That's kind of bringing everything together, all those tools and the people and then doing it just more efficiently. It is fast change, it is rapid, but it's change that is better for the processes and the people. - And I think I heard you also say like the Kaizen Week, right? Is that something about how these tools are brought to bear?

Is there's a certain time component that this is operating in? - Yeah, perfect question. So usually a Kaizen Event is held within about five days. I've done Kaizen Events too that are two or three days long. It depends on how much waste there is and what you're trying to tackle. If it's a specific, I always say if it's a specific waste and you kinda know where it's coming from, you can really tackle that probably in two or three days.

If you're starting out in an area and there's a lot of waste and there's just a lot to look at, then I tend to go with the five days. I do do some pre-work and post-work in the Kaiser Events that I do. I found that to be very helpful in doing some of the teaching 'cause that's kind of my goal along the way too is to teach all of this and the coaching piece of it and the tools along the way and bring everybody along on that journey.

And so the pre-work I usually do is, you know, really diving into what is the actual problems. We're trying to solve what is the waste that we're trying to eliminate? If we need to do value stream mapping, we'll do that before we go into that five-day Kaizen Event. Really getting that root cause analysis done. And then that way, you can go into the five days ready to test and you can get a lot more done in those five days.

I've ran Kaizen Events where we've tested up to 60 different things in a week. So it's rapid, it is good. And then usually I do some post-work too on the control plan. Okay, now that we've implemented these new processes and these new ways of doing things, how are we gonna keep that going? Who do we need to train? What do we need to update for SOPs? Things like that. And really put that control plan into place.

- I was really fascinated to hear you talking about and unpack that about that pre-work and post-work, right? 'Cause I think a lot of us are used to doing quality improvement and thinking about quality improvement as this is the thing in front of us that we're focusing on.

But I think what you're highlighting for everybody is the importance of setting ourselves up for success, such as, as you elaborated, identifying what is the actual specific problem. But then also I love this kind of almost like, you know, if we're use like a baseball analogy, like the follow through on the swing, right, of looking at afterwards like how do we keep this going versus that was good for a week, we did it, but how to keep that change being successful.

I'm curious about what are your thoughts? I mean, you obviously, I think you're supervisor of very busy complex laboratory setting. How do you kind of, you know, I'm curious for how you could talk to our audience about how you create that kind of culture of continuous improvement without everybody just feeling a lot of burnout.

If you're talking about pre-work, setting yourself up for success, these rapid dealing with 60 changes at a time and then post-op, I feel like I need to go have a break right now. How do you hold this off? - Good question. I really believe that the way that I coach and lead and develop people and empower people brings the buy-in into all that, right? This isn't me coming in and saying, "This is what you need to do and here's the change we're gonna make."

This is change that is coming from our people that are actually doing the work. It's their processes that we're trying to improve. And so they see that it's better for them and it works better and it takes away a lot of those pebbles in their shoes or things they didn't understand that were done, the reason they were done before and why they just kept doing 'em, 'cause that's how we've always done 'em, right? And this was their opportunity to come in and have a say in that work that they do.

It builds a culture where they get to be a part of improving their work and they get a say in their work, and it gets them excited again about, "Hey, this isn't so bad anymore. It's working." We get time with our patients or whatever it is that you're trying to do. I've done 'em all over Mayo Clinic, but we aren't losing as many specimens.

I mean, it's whatever you're measuring, but it just, I think that change management is built into that sustainability and that control plan, and then it gets people excited about it. We not only do Kaizens here, and I'm going on my third one just in a year and a half. We also have an improvement board where our staff, and I have 83 staff underneath me right now have the opportunity to, I call 'em Kaizen cards.

So they fill out Kaizen cards if they are seeing something that's not working in the area that they're working. And the three questions we ask is, what problem are you trying to solve? If they have some data surrounding how often it's happening or when it's happening, we like to hear that. It helps us kind of investigate a little bit more, and then if they do have any ideas on how to make it better, we have them put that on there too.

And so that's another avenue of how we get people involved in continuous improvement. And I think the change that is difficult for people is the change that's forced upon them that doesn't really make their processes better, where this is change that actually makes the processes better.

And so I think that is a key, is it better for the people? And if it is, they're gonna buy-in and they're gonna do it 'cause it makes it easier. It's less frustrating. So it just, I think, I'm pretty sure that's where it comes from, the buy-in and the control plan. - I love that, and I think that you just gave me a new question to be asking as I look at quality improvement projects and how we kinda go about these efforts.

If I'm critical of myself, sometimes there are cases where it sometimes feel like there's change that's implemented just because it's a change. That doesn't actually get to the heart of what the issue is. Which is why this conversation is so fascinating. I'm curious for our audience that may be listening to this that, you know, work outside Mayo and other institutions.

Are there resources that you recommend that are out there available that people can go to to learn more about Kaizen and the process? - Absolutely. I mean, from books to organizations to... I'm kind of a self-taught learner myself. The quality academy has a lot. I actually learned a lot through there and some of the people that were, have been my mentors over the years. But really self-taught. A lot of good books out there. I think one of probably the difficult thing

about Kaizens is, I get the question all the time, "How can we do these?" And you can't just go out and do 'em. Facilitators that have experience are pretty important in this because there's a lot of coaching that goes into it. Like you said, you don't want just changes to start happening, right? You gotta guide those, ask the powerful questions, get to the root cause, keep digging in. And so that facilitator is so important to running impactful Kaizens.

Usually when I train or do them, I kinda follow a process of see one, help with one, do one with some coaching on the side, and then if you feel comfortable, we'll kinda let you go out on your own. But it is a process and it's a lot to lead the big groups and keep them focused and all that kinda stuff. But the facilitators are very important in Kaizen Events and having some experience behind them.

- I think we'll work with you and get a couple maybe resources that we'll put in the show links here as far as for where people might get started, becoming kind of like this self-initiated education. And I'm curious then, you know, as you've participated in several of these, is there kind of a common fail point that you think?

So just to kinda put in the audience, if there's somebody out there in the audience that's interested in taking these next steps, gets a little educated, partners with a coach, is there a common fail point that you just want to kinda heads up, be on the lookout, here's something I struggled with maybe, for example? - I think there's a few things to look out for. If you already have a solution,

then Kaizen Events aren't for that. Like, that's then just an implementation, right? It's not process improvement. So if somebody comes to you and say, "Hey, I wanna implement this. Can you just do a Kaizen Event?" That's not really what Kaizens are for, right? You're going in, you're bringing people to the table. You're talking about the value stream maps where the waste is, how can we eliminate 'em? Going in with no solutions is really the key there.

And letting people kind of work through the problem solving and solving and have a say in that. I think the other thing to be very aware of is, there's gonna be resistance at the beginning 'cause this is new to a lot of people, but by day two or three, they're usually like, "Oh this is amazing." So you gotta really persevere through and coach through some of those that resistance and the difficult first couple days where it's new and they're learning.

Usually I get everybody there, and they're on board. And they're like, "Okay, this is great. Why we haven't been doing this forever?" So. - Well, you're good at navigating change management clearly.

What do you think of, you know, if you look at your laboratory now versus if you go kind of back a few years kind of pre-Kaizen, like we were talking about a lot of these elements or tools that we've been aware of, but you're really kind of bringing these things together in kind of a overarching holistic way. How has bringing the holistic, all these tools together? How is this kind of impacted the way that your laboratory functions? - Good question, so we use data. I've measured a lot.

And data's important more for the leadership side, right? Our people aren't really so invested in that data. Obviously, they wanna do a good job for our patients and get the results to them, but they're really, they're focusing on how well does it work for them. And so there's a, you know, I go back when I started in specimen operation 16 months ago and it was a tad bit chaotic. I mean, we're trying to deliver 40 to 60,000 specimens a day to the labs all over Mayo Clinic.

And we wanna do that as efficiently as we can and as well as we can.

And so putting some, just some of this Kaizen work into play and building better processes, our lab, our culture, our people are just happier that you go out on the floor, they love coming to work, they're laughing, we've built that commitment to the lab and to our vision, which is to service our patients and do what we need to do to get them the answers that they need to get or the physician so they can make their decisions faster and better for the patients.

But I think the culture is the big thing and getting everybody aligned with the direction we're going and give them some guidance in that area and then let them work towards that has been pretty effective.

As well as if you come out our areas organized, you know exactly what needs to be done, 'cause we're using, you know, like the 5S tools and things like that in some of our Kaizens to clean up and give direction via visual management, which is super important when you have 80 staff and they're rotating through five different pods of work, and having to know what they need to do. And so it just makes everything flow better as well, which is really what we want.

And so, but we are measuring too, like the one Kaizen that we did in our post archiving. So we save everything that goes out to the labs

that comes back to us so that if you need to rerun tests or do stuff like that, we can pull them again and get those specimens back out to the labs. And it was taking that area, that pod of work to pull and get those specimens back to the labs for rerunning tests about sometimes up to over 24 hours. We're down to under 30 minutes. So you request and we got it back out to you in no time.

- Wow. (laughs) - And that was all the result of the great stuff in the area that did the Kaizen and went through the process and really improved how they were doing the work, which is, that's what happens. I don't know how excited they are about that time, but they're excited that their area's no longer chaotic and it's calm and they know exactly what to do and they're getting the work done.

- Wow, so if I go back to something I said earlier in our conversation about like, you know, bringing all these tools to bear, is this just burning everybody out? It actually sounds just exactly the opposite. And I guess the sense is, it's the opposite because bringing them together together creates an effective change. And I guess to your point, an effective change that is empowering people and it's creating a process that is better for the people.

- Yeah, and you might feel a little bit chaotic in the moment when you're running the events, and it can be 'cause you're doing rapid testing. Once you get past that though, the end result is always... I mean, I've done 25, 30 of these, you always get some sort of good result out of them. They're all different results, right? But there's something that comes out of it that makes it better for the people and for our patients. And that's really the goal.

And then you just keep working on it and it's just continuous improvement. And once people see that, they get excited about the continuous improvement, then it doesn't really become that burden, kinda takes some of the way. I actually just had one of my leads say to me the other day that she's like, "It's so quiet and calm. I'm a little bit bored." I'm like, "Careful what you ask for." (laughs) We got lots more to work on. More opportunities for improvement, so.

- And on that note, we've been routing with Jessica Stellmaker talking about Kaizen Events. We really appreciate you taking the time to talk about this, introduce this concept to us. Thank you so much for joining us, Jessica. - Yeah, thanks for having me. - To all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email to [email protected]. If you've enjoyed this podcast, please subscribe. Until our next rounds together.

We encourage you to continue to connect lab medicine and the clinical practice through educational conversations. (bright music)