The Healthcare Manager's Playbook

Previous posts focused on value, waste reduction, and 5S, all of which rely on time being spent on site where the work happens. When a manager or leader spends time at the actual workplace, it is referred to in Lean as going to the gemba. Gemba is a Japanese term meaning “the actual place” or “the real place.” It is commonly used to describe the act of going to observe work being done with the intent to better understand processes, problems, and opportunities. It is often recommended as one of the first steps in improving a process.

The value of going to the gemba is that it immerses the leader in the process. Watching work happen in real time is one of the best ways to identify opportunities and understand the impact of changes being proposed or implemented. For example, if you are concerned about new complaints about slow and confusing admissions, going to the gemba would involve meeting a new patient at the door and staying with them to observe and learn from each step of the admission process. The idea is that direct observation provides insights that cannot be fully captured by reviewing data on a spreadsheet alone.

A few examples of times I have gone to the gemba as a director include observing how therapists and technicians prepare and post patient schedules, watching how outpatient admissions coordinators prepare charts and patients for therapy, observing how patients are prepared and transported to dining groups, and learning how therapists score patients on standardized tests at admission and discharge.

If you have not spent time visiting another person’s workplace, below are tips that can help make the experience more successful:

• Take Your Time. Spend the time needed to truly understand a problem or process before trying to solve it. Rather than settling for a surface-level understanding, slow down and invest the effort to learn the workflow in detail. The time you spend not only improves your understanding, it also builds trust and confidence with the team that you genuinely see and understand their challenges. During one visit, I realized I needed more time to understand workflows. As a result, I returned several times to fully understand what turned out to be a more-complicated-than-expected process.
• Be Respectful. Going to the gemba is like visiting someone’s home. You would not point out outdated furnishings or messes, as that would be rude. In the same way, do not be quick to point out flaws in someone’s workplace. Not only is it disrespectful, it can also be discouraging. This is where people spend their time and earn their living. Approach the environment as a guest. Always end your visit by thanking them for their time, input, and willingness to share their work with you.
• Be Patient. Avoid the urge to offer immediate solutions. It can be off-putting to suggest improvements after only a few minutes of observation. A mentor once taught me not to stop when you find the one way you might be right, but to continue looking for all the ways you could be wrong. Taking time to challenge your assumptions leads to better solutions and saves time in the long run.
• Take Notes. Bring a notebook, a way to track time, and the ability to capture photos or videos when appropriate. Document process steps, inefficiencies, and information flow. Note what systems are used and how long each step takes. Photos and videos allow you to revisit the process later. Rarely are the best insights visible during the first observation. The ability to review and reflect helps deepen understanding, which is critical for making meaningful improvements.
• Ask Questions. Ask the person you are observing to explain what they are doing. Have them walk you through each step of their process. Encourage them to share what works well and what does not. The people doing the work every day often have the best ideas for improvement. Do not overlook their perspective when identifying solutions.

Going to the gemba allows you to see work with your own eyes. There is significant value in observing and studying problems where they actually occur. Spending time understanding the work will help you make better improvements and see how changes truly affect the people doing the work. Time spent at the workplace is never a waste. Rather, it helps prevent the waste and frustration that come from implementing changes without fully understanding the work first.

About the Author: Shane Haas serves as the National Director of Outpatient Services at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys the consistent practice of building, improving, and sharing leadership and management skills. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers Playbook.

References:

1. Liker, J. K. (2004). The Toyota way: 14 management principles from the world’s greatest manufacturer. McGraw-Hill.
2. Ohno, T. (1988). Toyota production system: Beyond large-scale production. Productivity Press.
3. Graban, M. (2016). Lean hospitals: Improving quality, patient safety, and employee engagement (3rd ed.). Productivity Press.