The original Japanese term for Gemba comes from gembutsu, which means “real thing” or “real place.” Gemba promotes in-person observations where the actual work is being done and teaming with people in a spirit of Kaizen, or “change for the better.”
The Frankel Cardiovascular Center PFSAC started using Gemba in 2013, taking groups from its Patient, Family, Staff Advisory Council (PFSAC) into inpatient areas to engage with staff and patients. “Our goal was two-fold: one was to get patient advisors to interact with staff and, two, to help our advisors who may be far out from their inpatient experience to feel reconnected,” said Michele Derheim, Director of Clinical Operations for the Frankel CVC.
Each PFSAC Gemba focused on a certain outcome of care: inpatient stay as a whole, discharge, and what PFCC means to staff. On one of the Gembas, a patient mentioned being asked not to use her call button so frequently. The issue was brought to nurse managers who reinforced better communication techniques with their staff that benefitted both patients and nurses. The Gembas also served to raise awareness among the staff about the Patient and Family Centered Care Program.
“It’s important to stay connected to the care so that we can make this the best patient experience possible and keep improving,” said Derheim. “The feedback from the staff and advisors has been very positive.”
In March, Ruste Wilke, senior manager UMH Ops and Ancillary Services Administration HHC, organized a Gemba for a project by Norma Merritt, UMHS Main OR afternoon manager, to improve upon patient and family services related to the waiting room delays for the OR. Wilke is also a PFCC advisor. Melissa Cunningham, PFCC volunteer coordinator and advisor, was invited to join.
Merritt learned that the Cardiac Procedures Unit has developed a patient-centered approach in their waiting area, so she went early to observe Patient Liaison Noreen Myricks in action. What Myricks did seemed so simple, yet yielded noticeable results.
“She went family to family, updating a husband on his wife’s status, asking if they need coffee, pushing information instead of the families having to pull information from staff.” The results were visible, said Merritt. “There was a peace in that waiting area and the families were relaxed.”
In the OR waiting area, Merritt noted, sometimes patients have to wait upwards of eight hours to be taken back to pre-op for their surgeries. This leads to increased patient anxiety; family members get angry and stressed. In addition, patients waiting for surgery often experience a drop in blood sugar levels which can lead to fatigue, dizziness, and nausea.
In the Frankel CVC Cardiac Procedures Unit, Myricks facilitates communication and patient flow between the waiting room, pre-op, surgery, and post-op. Myricks has developed a script that informs patients and their families about all of the vital information they will need to keep updated on the patient’s status and to be comfortable during their wait. After walking the patient back to pre-op, she updates each family every two hours and even advises them when it might be a good time to take a break and get a bite to eat. Most importantly, she will check on their loved one if the surgery is taking longer than expected. “I make sure to give that update every two hours,” said Myricks. “If we don’t, the families get very nervous.”
Janice Norville, senior administrative manager for the CPU, shared the story of how she used to watch Myricks work as a patient liaison for Mott Children’s Hospital. “I knew we needed that at the CVC,” she said. In addition, Nurse Manager Sheryl Wagner pointed out the MiChart tool that is also used to update families as well as a card station where children can make get well cards for their loved one.
The Gemba walk continued the next week at the ER waiting room. There, Merritt shared what she learned with Aaron Brown, ER Clerical Manager, and Jill Maloy, OR Administrative Manager.
“Patient wait time will continue to be a challenge for the Emergency Department,” said Brown. “From my perspective, the key thing for our clerical team is to keep the guests informed and anticipate need. Answer the questions they may not realize they need to ask, such as directions to restrooms, or food options, or where to go to get cell phone signal.”
Myricks will be sharing her script with both the OR and ER, as well as her observations from a Gemba she took to the OR waiting area.
“The biggest take-away for me is letting us own the change – the whole staff,” said Merritt, “and educating clerks and nursing staff to take ownership for each and every patient and family.”