Importance of rounding or going to the “gemba”

In lean speak, you have to go to the “gemba”, that place where the work is done. GembaTo go to the “gemba,” I rounded with some of my colleagues in the early days of our inpatient Epic go live. They included our Chief Medical Informatics Officer (CMIO), the executive director of our children and womens hospital, and our Chief Nursing Officer (CNO).  We visited many different inpatient units – to listen to staff tell us how it was going and describe issues. It reminded me that I need to once again make time to regularly round with our users.

In every industry, IT leaders should do rounding – either on their own or as part of structured rounds led by others. How else will we hear from front line users of the systems we implement and support?  How else will we hear what really works and what doesn’t? How else can we stay grounded in our users’ experience with the systems and tools they need to do their jobs? How else can we understand what they need from us?

When I was CIO at Brigham and Womens Hospital in Boston, I participated monthly in the Safety Matters: Executive Walkrounds. These walkrounds occurred every week, led by the CEO, COO, CMO or CNO. I joined the ones I could fit in my schedule, at least monthly. I knew that Id hear the good and the bad – what our users loved about our systems and what they didn’t like. What they were waiting for us to change and improve.

At UMHS, we have formal Patient Safety Rounds facilitated by our Chief Medical Officer (CMO), Dr. Skip Campbell.  He and Maureen Thompson, Operations Director, Chief of Clinical Affairs, have conducted the Patient Safety Rounds since 2002. They happen every two weeks and are one hour long. They include participation by the CEO, COO, CNO, Dr. Jack Billi, as well as reps from Pharmacy, Material Services, Risk Management, Infectious Disease, and others.

Their purpose is simple:  engage the staff in describing barriers to patient safety. Dr. Campbell conducts these informal rounds with staff at the “gemba”, where people work.  He asks open ended questions, such as “What is the next error likely to happen?”. The staff speaks openly about patient safety and system issues. The Patient Safety Committee, chaired by Dr. Campbell, reviews the feedback from these rounds regularly within committee meetings.

I joined the Patient Safety Rounds at UMHS last week for the first time. I heard firsthand about a range of issues. When senior leadership shows up and takes the time to listen to the staff, issues besides patient safety come up, including IT issues. New issues and ones we are aware of and working on already. Needs that could be better supported with innovative technology solutions.

I have the opportunity twice a month to join these Patient Safety Rounds and hear from our customers, so there are no excuses. If I am not there, one of my senior leaders will be.

One of my next challenges is planning “gemba” walks with my IT leadership team within our own department.  As I said in a recent blog on lean, going to the “gemba” in an IT department is difficult; the majority of staff work in cubicles on computers. The “gemba” is clear in manufacturing – the assembly line.  It’s clear in a hospital setting – the patient care and support service areas.  Where is the “gemba” in IT?  You don’t take “gemba” walks in the hospital by attending staff meetings, you go watch people work.  That’s the challenge of knowledge workers, there isn’t much to watch. What exactly is the team’s process to observe and understand on a “gemba” walk? Time to figure that out!

5 thoughts on “Importance of rounding or going to the “gemba”

  1. Jeanne Kin on said:

    Great post Sue! Coincidentally, there is a new post on “Going to the Gemba” on the LEI website contributed by our mentor Dave LaHote: http://www.lean.org/LeanPost/Posting.cfm?LeanPostId=259 His description of a gemba walk is in the manufacturing environment, but the questions he asks: (Why are you taking the walk? What are you trying to deeply understand? How will you take the walk?) are relevant to any environment.

  2. Andrew Gutting on said:

    I would challenge your statement regarding going to the gemba being difficult in an IT department. I think who our direct customers are as an IT department (Nurses, Doctors, Clerks) is different from who the direct customers of our Nurses, Doctors and Clerks are, which would be our patients. When Toyota speaks of going to the gemba, they don’t mean going to their customers and sitting in a Prius with them for a road test (although obtaining feedback about customer experience is extremely important), but going to the place where that Prius was manufactured and becoming intimate with the issues that are getting in the way of manufacturing the best Prius possible.

    Our customers are the clinicians that care for our patients, but the tools that they use to provide that care are manufactured…well, in my case, right at Domino’s Farms MiChart. So I would absolutely encourage you to head over here and Go See, Ask Why, Show Respect. I bet you would become very intimate with the daily challenges that we encounter on a daily basis that get in the of manufacturing the best MiChart possible. More importantly, you might encounter some wonderful improvement ideas from my colleagues that you can give a hand in helping us implementing.

  3. Melissa Manley on said:

    Great post!! Losr my original response but believe there are many wats to break up IT to go to the Gemba. There certainly are concerns and barriers that need to be heard and resolved….not all in one day if course. Just knowing that leadership is interested and willing to listen will increase knowledge throughout the department. Would recommend breaking it into areas to make it somewhat manageable (I.e., application coordinators, training team, help desk, bedside equipment, etc.) there are many dependencies in the time that can lead to barriers impacting timelines and quick resolution.

  4. Pingback: Go to the gemba, seek to learn | sueschade

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