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A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
(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 mcleducation@mayo.edu.
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)