At the Gemba, in Georgia


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Southwood Medical Center, Kaiser Permanente

Kaiser Permanente Southwood Medical Office, Atlanta, Georgia

I am currently in the Atlanta area, visiting colleagues in the Kaiser Permanente Georgia Region, my first Gemba-walk in my position with The Permanente Federation. In order to be able to do what I am going to do for my new employer, I need to go where value is created (to use a Toyota derived concept), which is where patients/members receive care. Of course in this system, members can receive care outside of the medical office, too, because of kp.org’s My Health Manager.

If you’re asking: “What’s the Gemba, Ted?” : I’ve written a few blog posts on what it means to do a Gemba Walk in health care click here to read more about what the Gemba is and how a Gemba Tour in health care can work -there is a method to this.

I shadowed three primary care physicians today at the Kaiser Permanente Southwood Medical Office. I learned that there is good proficiency with the installed Electronic Health Record (KP HealthConnect) and with the idea that patients have secure, private access to their personal health information, through their use of kp.org.

Kristyn Greifer, MD is the Associate Medical Director for Ambulatory and Hospital Medicine here, and is my Southeast Permanente Medical Group host. She and her team are supporting my learning through observation at the point of care. It makes a huge difference to start here – I encourage it of anyone interested in improvement – and I appreciate the hospitality of the members and staff here in teaching me how they get and stay healthy in a modern healthcare system.

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e-Patient Dave
e-Patient Dave

> incorporating this into your practice

Oh for heaven's sake yes. Years ago my work in graphic arts technology involved what we might call "production transformation," and I was known as the guy who'd get out of the conference room and go see what was happening at the keyboard, at the paste-up table.

Now that I think of it, that's where I first developed a sense for having the right information and process in the right place at the right time. At my very first job, doing typesetting in the print shop of a school for handicapped kids, I ended up redesigning the job ticket, to reduce the need to stop work and go ask questions about what someone wanted, and reducing the frequency of production errors.

Hm! Never connected those dots before.

Anyway, yeah, go ask (or watch) the people who are doing the work. Yeah. (And the people who are receiving the care.)

Ted Eytan
Ted Eytan

Dave,

Oops - next time I should just answer the question and not assume that you were asking something else - thanks for following the bread crumbs and maybe incorporating this into your practice - walk in my/their shoes---?

Ted

e-Patient Dave
e-Patient Dave

Thanks for your generosity in providing those links. I had already gone to your DailyKaizen blog and searched for "Gemba," finding mostly what your de.li.ci.ous link showed, but I still didn't find a teaching about what gemba is, the Toyota discipline. Nor so I see it spelled out in those linked articles!

BUT, with what you wrote in the previous comment, and those articles, I have a good sense of it.

It's such a good concept. Asking people what they *think* they do is always so dicey.

Ted Eytan
Ted Eytan

Hey Dave,

On the heels of your comment, I have taken the cooperative opportunity to clarify the second paragraph of my post to point to three blog posts I've written previously about Gemba tours. Blogging = continuous improvement publishing!

Since you took the time to point out the lack of clarity, I will save you some here by defining Gemba as "the place where value happens for the customer." In a Toyota plant, this could be the place where the car is built. In health care, it's where the patient receives care.

The approach of "allow me to visit your health care organization by directly observing how patients receive care rather than having meetings in boardrooms" is not an established one in the industry. Far from it. However, I can report that just about every organization who I have asked to show me how they work by allowing me to see how patients receive care have supported me in doing this, including Kaiser Permanente Georgia. It makes an impression when I think about who I would like to work with. And there's no question about it - 10 minutes observing the process of care is more valuable than 1,000 minutes in a conference room.

Second day at the Gemba post is coming next,

Ted

e-Patient Dave
e-Patient Dave

I was going to go google Gemba myself, but I figured I'd take the opportunity to remind you that not everyone knows what you're talking about. (Heh)

Have you talked about it over at DailyKaizen?