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Cited by 68Healthcare Quality and ManagementEmergency and Acute Care StudiesQuality and Supply Management

Kaizen: a method of process improvement in the emergency department

Open access
Jacobson, Gregory H., McCoin, Nicole Streiff, Lescallette, Richard, Russ, Stephan, Slovis, Corey M.·2009·Academic Emergency Medicine
DOI 10.1111/j.1553-2712.2009.00580.x
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Abstract

Introduction: Recent position statements from health care organizations have placed a strong emphasis on continuous quality improvement (CQI). CQI finds many of its roots in kaizen, which emphasizes small, low‐cost, low‐risk improvements. Based on the successful Kaizen Programs at organizations such as Toyota, the authors thought the emergency department (ED) would be an ideal environment to benefit from such a program. Objectives: The authors sought to create a CQI program using a suggestion‐based model that did not require a large time commitment, was easy to implement, and had the potential to empower all physicians in the department. It would not take the place of other improvement efforts, but instead augment them. The hypothesis was that such a program would foster sustainable engagement of emergency physicians in system improvement efforts and lead to a continuous stream of low‐cost implementable system improvement interventions. Methods: A CQI program was created for the physician staff of the Department of Emergency Medicine at Vanderbilt University Medical Center, focusing on a suggestion‐based model using kaizen philosophy. Lectures teaching kaizen philosophy were presented. Over the past 4 years, a methodology was developed utilizing a Web‐based application, the Kaizen Tracker, which aids in the submission and implementation of suggestions that are called kaizen initiatives (KIs). The characteristics of the KIs submitted, details regarding resident and faculty participation, and the effectiveness of the Kaizen Tracker were retrospectively reviewed. Results: There were 169, 105, and 101 KIs placed in the postimplementation calendar years 2006, 2007, and 2008, respectively. Seventy‐six percent of KIs submitted thus far have identified a “process problem.” Fifty‐three percent of KIs submitted have led to operational changes within the ED. Ninety‐three percent of the resident physicians entered at least one KI, and 73% of these residents submitted more than one KI. Sixty‐nine percent of the attendings entered at least one KI, and 89% of these attendings submitted more than one KI. Conclusions: Over the past 4 years, the Kaizen Program at Vanderbilt has been widely and frequently used within the ED. It has resulted in over 400 changes in our adult ED system and has met the challenge of using CQI to drive ED improvements. There are limitations to this study, including the fact that its impact on patient outcomes remains unknown. However, this Kaizen Program may be an excellent tool for other departments to assist with quality improvement and should be studied with a multicenter prospective approach.

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  • Participating in Lean led frontline staff to take control of their own work.

    “some studies suggested that Lean may have even brought about a new participative, continuous improvement culture such that participating in Lean led frontline staff to take control of their own work and to participate more in shared governance [76, 78, 83].”

    From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [78]

  • High participation rates in process improvement described in one study are a testament to empowering effects of Lean.

    “the high participation rates in process improvement described in one study are a testament to such empowering effects of Lean [78].”

    From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [78]

  • Some studies suggested that Lean may have brought about a new participative, continuous improvement culture.

    “some studies suggested that Lean may have even brought about a new participative, continuous improvement culture such that participating in Lean led frontline staff to take control of their own work and to participate more in shared governance [76, 78, 83].”

    From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [78]

  • Participating in Lean led frontline staff to participate more in shared governance.

    “some studies suggested that Lean may have even brought about a new participative, continuous improvement culture such that participating in Lean led frontline staff to take control of their own work and to participate more in shared governance [76, 78, 83].”

    From Lean Thinking in Emergency Departments: A Critical Review (2011) · cites this paper as [78]

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1 of the 33 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Juran J. Managerial Breakthrough. New York, NY: McGraw-Hill, 1964.

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Authors
Jacobson, G. H., McCoin, N. S., Lescallette, R., Russ, S., & Slovis, C. M.
Affiliations
Vanderbilt University Medical Center (US)
Corresponding author
Slovis, Corey M.
ORCID
McCoin, Nicole Streiff
Venue
Academic Emergency Medicine
Publisher
Wiley
Published
2009-12
Volume
16
Issue
12
Pages
1341-1349
ISSN
  • 1069-6563 (ISSN-L)
  • 1553-2712
DOI
10.1111/j.1553-2712.2009.00580.x
OpenAlex
W2031409617
Cited by
68
References
33
Citations by year
2025: 2 · 2024: 4 · 2023: 6 · 2022: 1 · 2021: 7 · 2020: 5 · 2019: 4 · 2018: 3 · 2017: 7 · 2016: 6 · 2015: 6 · 2014: 4 · 2013: 4 · 2012: 3
FWCI
6.32
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Academic Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Social Sciences › Business, Management and Accounting › Management Information Systems › Quality and Supply Management
Keywords
Kaizen, continuous quality improvement, emergency department, web application, resident engagement, employee empowerment, process improvement, low-cost interventions, quality improvement culture
MeSH terms
Adult, Emergency Service, Hospital, Humans, Retrospective Studies, Tennessee, Program Evaluation, Program Development, Models, Organizational, Total Quality Management, Organizational Case Studies

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