Go to the gemba, seek to learn

I’ve written about gemba walks. Gemba is the Japanese word for “the real place” or that place where the work is done.

I am fond of a quote from President Dwight D. Eisenhower: “Farming looks mighty easy when your plow is a pencil and you are 1,000 miles from the corn field.” Gemba basicsWhile I don’t know the specific context for the quote, it applies to business today. As leaders, unless we see the way work happens on the front line, we cannot understand the problems we need to solve and the barriers we need to remove. That doesn’t happen by just meeting in a conference room.

All hospital leaders were assigned to do at least three gemba walks this summer. The walks are supposed to be an example of each of the following:

  • patient and family experience such as observing check-in
  • front line staff experience such as shadowing someone or attending a unit’s daily huddle
  • “break out of your silo” experience such as observing one of your downstream customers or walking a “value stream” (a high level view of how work gets accomplished across multiple departments and physical locations)

We are expected to report back at our next leadership forum in September on what we learned.

To prepare to “go to the gemba” We were given the book “Gemba Walks” by Jim Womack, founder of the Lean Enterprise Institute. It’s an easy read. It is a compilation of short essays from his 30 years doing gemba walks in all types of organizations all over the world.

Mary Martin joined our health system a year ago as associate hospital director for operations and clinical services. Previously she had extensive experience leading lean efforts at Detroit Medical Center and led the turnaround efforts of Detroit’s city operations under Mayor Mike Duggan using lean methodology. To kick off the summer gemba assignment, Mary shared her own experiences. As a weekly practice, she spends 2 hours every Wednesday afternoon doing a gemba walk with a frontline staff member in one of her 7 areas.  At first that sounds like a lot of time but not when you think about the unproductive time spent in meetings and email trails. Through this weekly practice, Mary has been getting closer to the real problems that she and her management team need to solve to improve operations in her areas.

So far I have visited the Cancer Center observing patient flow at registration and check-in. I also spent an hour with a desktop support technician as he worked assigned tickets throughout the hospital on the evening shift. I also observed his team’s twice a day shift change huddle. Next week I’ll be spending a few hours at our level 2 service desk observing what it takes to support our clinical customers.  And I’m scheduled to do a value stream walk following a patient who comes in through the ED and ends up having a procedure in the Cardiovascular Center.

When you do a gemba walk you are expected to observe, ask questions and show respect. It is not management by walking around. It is seeking to learn. You want to empower staff and encourage them to identify problems and solutions with their direct management. As a senior leader, you need to recognize what are broader, systemic problems that you have to help address.

Whether I do a gemba walk in my own area or another, I hear about and see issues with technology and the systems that we support.

Thanks to Will Garner, desktop support specialist, I got a good firsthand view of the kinds of problems he and his team solve, the overall ticketing and work assignment process, and how we actually provide support services.

At the Cancer Center, the operations manager, Robin Napieralski, walked me through the flow issues from when patients and their families first enter the building, come off the elevator on the right floor, and find where they should check-in. She and other staff answer questions and direct patients to the right place all day long. Better signage and clarity about where to go to check-in are opportunities for improvement. And of course, if there is a printer problem at check-in, the line backs up creating even more of a flow issue. That ties back to the desktop support process and improvement opportunities there for quickly servicing urgent tickets.

I expect on the upcoming gemba walks that I’ll get a better sense of how our EHR functions to support a critical patient flow from the ED. I will also see the challenges in supporting our clinical customers through the service desk.

And as both Will and Robin can attest, I will ask plenty of questions as I seek to learn.

Resources:

Gemba Walks by Jim Womack

4 thoughts on “Go to the gemba, seek to learn

  1. Andrew G. on said:

    Seems to be some formatting issues with the “” characters, resubmitting:

    Our team has recently implemented a weekly gemba to one of the OR/procedural sites we support to gather issues and understand our customers needs on a deeper level. The “Ask questions” component to gemba is so critical, with “why?” being the most important question of course! Often however, asking “Any problems today?!” usually leads to “Nope, no problems!” (No problem is problem!) Unfortunately, the customers that use our software are sometimes so accustomed to waste that they no longer see it as an issue, but just a part of their daily work. On our gemba form we have a section for “Questions to ask” which includes:

    Tell me about [insert workflow] What part of that workflow is frustrating to you?
    What part of [insert workflow or known issue] could be improved? How?
    Show me how you do [insert workflow]
    What ideas do you have to make MiChart better?
    Tell me about your most frustrating MiChart experience

    This sort of questioning is much more likely to surface issues and create meaningful dialogue. It is still a new concept for us so after our first gemba visit, the two team members that did the walk reported to the larger team about what went well and what didn’t, making recommendations as to how to tackle the next one. We will continue to report not just the issues that come out of our gemba walks, but also how to improve the process each an every time.

    • Sue Schade on said:

      Andrew, Thanks so much for sharing this story. Your specific questions are great. Should get insightful info. I’m encouraged by all the lean experiments that are starting to happen within MCIT. Keep it up!

  2. Annie Browning on said:

    Sue, I love this post, especially this “When you do a gemba walk you are expected to observe, ask questions and show respect. It is not management by walking around. It is seeking to learn. You want to empower staff and encourage them to identify problems and solutions with their direct management. As a senior leader, you need to recognize what are broader, systemic problems that you have to help address.”

    One question: How might we help people who feel like we are questioning their judgement by asking questions, to feel more comfortable?

    • Sue Schade on said:

      Annie, great question. The tone you set is key – you are seeking to understand and learn. Showing respect for their work in all your words and manner is key as well.

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