A Practical Guide to the Kaizen Approach as a Quality Improvement Tool.

Abstract

Quality is a prominent subject in healthcare, with the ultimate objective of maintaining a high level of patient satisfaction while increasing profitability and patient safety.[1] The goals are constantly shifting and potentially affected by several external factors. When a healthcare institution has barriers to reaching goals in meeting cost-effective objectives and improving patient safety, it is vital to identify the core causes and take necessary steps as quickly as possible.[2] One quality enhancement concept in healthcare is to do it right the first time; therefore, it is important to respond quickly to an undesirable condition or problem and analyze the most critical contributing factors that led to it. Healthcare systems are classified as complex adaptive systems; they are the hardest systems to understand and manage because a single problem might be related to several contributing parts simultaneously.[3]Kaizen refers to ongoing or continual improvement and comprises the following two Japanese words: kai, meaning “change,” and zen, meaning “good.” The Japanese term translates to “constant improvement.” It is a concept of “doing better every day, with everyone, and everywhere.”[4] The Kaizen philosophy questions the phrase, “that is just how we do things.” It tries to eliminate silos, egos, and waste through microchanges and instead aspires to efficient and standardized operations.Kaizen is a method of producing continuous improvement founded on the premise that tiny, continual positive adjustments may yield substantial results. Often it is established on collaboration and commitment rather than techniques that employ drastic or top-down reforms to achieve transformation.[5] With an emphasis on making incremental, regular improvements to current processes, the improvements are developed by all employees at all levels, not just by managers and executives. For example, when applied to the use of technology, Kaizen has the potential to improve every aspect of an organization, from marketing to finance to warehouse management. Toyota pioneered the Japanese idea in the 1980s, and subsequently, hundreds of businesses worldwide have used it.[6,7] Known as “the Toyota way”, Kaizen has subsequently gone around the world to be used in situations other than business and productivity.Kaizen is classified into the following two types: large Kaizen and small Kaizen. The large Kaizen is comparable to the FOCUS (find, organize, clarify, understand, select)–PDSA (plan, do, study, act) quality improvement method (FOCUS-PDSA) in that it involves an advanced examination of the issue statement with many implementation processes. Whereas small Kaizen, also known as Teian, is an idea that comes from anybody who wants to improve a current situation by finding a fast remedy and observing the difference.Primarily, the Kaizen approach is used in the issue identification phase of a quality improvement project; however, it also functions in the data analysis and outcome evaluation phases after a specific intervention.[9] The intended outcome in Kaizen must be supported by maintaining several smaller contributing improvements. Kaizen, or quick improvement processes, is sometimes regarded as the “foundation” of all lean manufacturing approaches.The Kaizen approach consists of the following five founding elements: teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. A quality project that was recently initiated used the Kaizen approach; although it was similar to PDSA, the difference in technique was the use of teamwork in initiating the project. The project involved reducing hospital-acquired pressure injury (HAPI) and with the Kaizen approach, the HAPI rate showed improvement within 6 months (Figs. 1, 2).The desire to make a difference provides a great incentive to apply the change principle. Begin by identifying an issue or a scenario that requires improvement. Then, determine the elements that contribute to the problem and their frequency. Enter the data into the Kaizen format to identify areas for improvement and change. Using a small Kaizen approach allows the staff an opportunity to promote ideas for small quality projects that can be completed within a short time. These successes encourage the staff as they see their ideas applied. For example, employees in the intensive care unit rearranged and labeled oxygen cylinders. They first separated the full and empty cylinders into different cabinets and then labeled the cabinets as either full or empty. The reorganization and labeling allowed healthcare workers to quickly distinguish between the cylinders. Particularly in emergency cases, this change will enhance patient safety, work efficiency, and even save lives. Previously, comparative research was conducted to incorporate Kaizen as a quality tool to reduce the average length of stay.[10] The Kaizen quality approach gives the team energy to have collaboration, personal discipline, high morale, and suggestions for continuous improvement as well as to distribute responsibilities.Both the ideals and practice of continuous improvement and Kaizen are supported by the PDSA method. Kaizen focuses on making modest, daily adjustments to increase results over time. The PDSA cycle provides a framework and organization for discovering and objectively evaluating improvement possibilities. FOCUS-PDSA is an effective quality approach; however, the Kaizen method improves team engagement, communication, teamwork, the development of new ideas, and more involvement over time.The Kaizen technique is a helpful tool implemented in various stages of quality improvement initiatives and serves several roles. Applying the Kaizen idea to quality improvement projects in healthcare will save time, money, and effort.Using a variety of quality tools, as well as increasing the engagement of healthcare professionals and personnel, will aid in enhancing patient safety and cost-effective practices. Kaizen, whether large or small, may be used by everyone and is not limited to the healthcare field.