3 Lessons From Going To The Gemba
Healthcare’s tectonic shift from volume to value based and intensified focus on preventative care and new economic models and incentives is bringing new challenges to the industry, which in turn demands new problem-solving strategies.
Deborah Adler, a designer, entrepreneur, and founder of Adler Design (New York), illustrated one idea during her closing keynote presentation at the 2015 Healthcare Design Expo & Conference, as she shared career highlights and design solutions born out her practice of going to the gemba, a Japanese term that translates into the “real work,” or the place where the work is done.
“Every encounter in a healthcare space has a gemba,” she said, from the OR to the supply room.
Design teams need to go to these places to see the steps and the processes so they can figure out what the issues are and how design can help resolve them. “We need to make those places our desk,” she said.
Adler’s career path to the healthcare sector was in response to a medicine mix up when her grandmother accidentally took her grandfather’s medicine. A master’s student at the time, Adler recognized how the small prescription label that curved around the bottle was hard to read and that the hierarchy of information wasn’t geared to the user.
The experience inspired her to change her thesis project to focus on redesigning prescription drug packaging, leading to the development of ClearRx—a design that was picked up and adapted by Target.
In this case, Adler said the gemba was her grandparent’s medicine cabinet where was able to see the difficulties her grandmother had in recognizing her own medicine bottle and what was inside. “My goal was to give them more clarity,” she said.
Sharing examples covering design, branding, and packaging, Adler offered several lessons she’s learned from going to the gemba, including:
1. Don't design for the world, design for the person
Showing a picture of a shelving unit stuffed with nearly identical surgical procedure trays, Adler pointed out that while there’s a tray for every operation, they’re all basically the same—big, bulky, and blue—making it difficult for the staff to easily discern which tray they need in a timely manner. “This is an environment where you need speed and exactitude,” she said.
By observing their location in central sterile supply and the process for the staff to get a tray, Adler sought to add more system thinking to the process to eliminate confusion, increase efficiency, and reduce waste.
Her redesign featured trays that are color-coded by procedure, such as purple for orthopedics, and then further defined by surgery type, helping ensure that staff members pick the right one. The color-coding also helps increase the speed of restocking since it’s easier to identify which supplies are low. Her firm also created a new label with a checklist that helps track what supplies weren’t used so organizations can work to reduce waste.
“By watching, you’ll learn a lot,” she said.
2. There’s always a better way
On another project, Adler’s work in the gemba took her to the patient room to observe the process of putting in a catheter. Noting the high rate of catheter-associated urinary tract infections, Adler witnessed how the supply kit had two layers, making it a challenge for staff to keep the catheter from falling on the floor while reading instructions and preparing the supplies. “The goal was to make it a more sterile experience but also calmer,” she said.
Her firm designed a one-layer system that simplifies the steps and keeps the catheter in place until it’s ready to be used. A stop and check protocol is part of the label and can be removed and added to the medical record to improve the work process.
After going back into the gemba to test the new kit design, Adler realized the patient education materials were still being missed and thrown away, representing “not just waste but a wasted opportunity.”
She decided to transform the patient education materials into a Hallmark-type card that’s placed on top of the kit to make it more noticeable and more welcoming. “It invites a relationship between the nurse and the patient,” Adler said.
3. The little things are the big things
Patients today are making more informed decision, which means everyone from the C-suite on down needs to focus on improving patient satisfaction and outcomes and providing better experiences for all.
Working with Dignity Health and Medline, Adler and her team did research in the gemba to discover key factors that contribute to a positive patient experience, including a quiet environment, cleanliness, and interaction with the staff. The research led to the development of quiet kits for patients facing an overnight stay at the hospital and include such items as a sleep mask, lip balm, ear plugs, and a paper pad to write down questions. “The right touch can create lasting trust,” Adler said.
In closing, Adler said the challenge for healthcare designers, architects, interior designers, and owners is to create the gembas but also to keep their eyes open to observe all of the encounters that are available for observation.
“There’s truth beyond the data when you go into the gemba,” she said.