“Sometimes the best kaizen is no kaizen at all.”
- Jon Miller, Kaizen Institute
Well, maybe only sometimes. Reflecting on a recent Rapid Improvement Model (RIM) approach, I had my first exposure to the idea that there are many ways to engage in improvement. Not every problem is the same nail, and not every respective improvement is the same trusty hammer.
Colleague Jennifer Haury and I teamed up with Group Health clinical leaders to tackle an A3 for Hypoxia/Hypoxemia. Hypoxia is the diagnosis of low oxygen saturation in body tissue and hypoxemia is a diagnosis of low oxygen saturation specifically in blood.
As it turned out, there was not a standard for how oxygen therapy was managed across the delivery system. However, there was drafted standard work. There were tools in place to help document and code for oxygen therapy, but an additional gap: the lack of adherence to the existing standard work existed. Sounds like a great problem to solve with an improvement event, doesn’t it? Well, as it turned out, the operational leaders had a better idea. They said “let’s create a standard right now, slightly improve and spread the already created standard work, and check on the work to see how we do! We don’t need an event. We need to just do it!”
So they created a standard that every time oxygen equipment is ordered it is ordered as a prescription in the historical medications list. Therefore, every authorization submitted to the Health Plan for equipment order through a durable medical equipment vendor will be linked to a prescription in the medical record. And every patient on oxygen according to the Health Plan will have a medical record review to validate documentation and coding. Next year, Group Health should see an increase in both the number of patients correctly diagnosed with Hypoxia/Hypoxemia, and an increase in capitation revenue to care for those patients; to the tune of >$2.7M.
So it is true that not every improvement needs to be done using an event to accomplish results. The constant necessity is that good thinkers acting bravely achieve great results. When leaders actively define standards, diligently create and implement standard work, and routinely check on adherence to standard work, improvement happens.
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