The Importance of Team Work in Healthcare
The challenges of organising healthcare in a public hospital are considerable. The best and most cost-effective outcomes are achieved when professionals work together, learn together, deliver and implement innovations for higher quality patient care. The Continuous Improvement Team at Papageorgiou Hospital in Thessaloniki, is a cross-departmental team, with the objective of solving simple and complex interdisciplinary problems and making suggestions for continuous improvement of processes.
Continuous Improvement Process
The process of continuous improvement is based on simple mechanisms of the human brain, where thoughts and actions are organised in such a way that an action “triggers” a thought, a feeling and vice versa. If the brain of all employees is geared to find solutions instead of problems, then a huge step towards success has been achieved (Goetsch,D., Davis,S. 2010). Continuous improvement should be a perpetual effort, which eventually becomes part of everyday culture.
In order to achieve this, people need to be given incentives to encourage creativity and innovation in all sectors, to have space for experimentation without criticism, opportunities for expression and tolerance of a number of errors as a normal consequence of the learning process and development. The incentives do not always have to be economic. The work itself can be designed in such a way so as to offer an approach of pleasure and creativity.
The Japanese word kaizen in free translation means "improvement" and it refers to the philosophy of continuous search for better ways to achieve what we do through a collective process. The Kaizen organisation model was applied for the first time at the Toyota plant in Japan in the early 50s, and later it was adopted successfully by other large companies (Creative Safety Supply 2010). The law of continuous improvement (the Kaizen principle) says simply that everything can be improved even though "it already works well". Everything can become even better, cleaner, of better quality, cheaper, faster, safer, more beautiful and more efficient. There is always room for improvement in all areas and we have to seek and find them.
The adoption of the Kaizen model indicates efforts to improve procedures, with minor but essential changes, with modern commitment to obtain excellence through continuous monitoring and improvement of workflow, day after day, without costly solutions (Hassan Α. Tetteh 2012). The basic principle is the achievement of small, direct improvements in processes and workplace standards, with modern restriction of "trash", meaning actions which do not add value. In the long run, all these small added changes lead to better working conditions, higher safety, greater efficiency and ultimately greater benefits.
In a successful Kaizen process, management and employees work together to obtain the desired improvement. Employees do not just express their ideas. They get involved in the actual implementation and evaluation of results. Managers do not just assign activities to improve the staff. They participate and are involved as coaches, facilitators and leaders. This is a team effort. The application of the model changes for the future the manager-employee relationship. The job of the manager is now to motivate and inspire his or her people.
Κaizen and Healthcare
Scientists, studying the quality of healthcare from the late 80s, found that the Kaizen model could be applied to other sectors, apart from industry. It became obvious that one of the biggest obstacles to the effective implementation of healthcare systems was the lack of respect for employees, which caused frustration and lack of commitment of the staff.
One peculiarity regarding the implementation of the model in the healthcare system, is the fact that management cannot require employees simply to reduce costs. The cost reduction, as primary objective, does not "inspire" health professionals (Mark Graban (2014). On the contrary, they get excited when the target is to reduce the risk or trauma to the patients, improve satisfaction of patients and attendants and the reduction of frustration and conflicts that they have to face daily. Specifically, nurses constitute the group of staff that can greatly contribute to improving health services. Being involved in the continuous care of patients, they are able to make great changes and bring about improvements in the procedures, which will lead to better quality services and more generally, to significant progress in the health sector (Domingo R. 2003 ).
Countless improvements can take place in healthcare facilities for the benefit of patients and their families, for the staff and physicians and significantly and measurably, for the health system itself (Bandyopadhyay J.,Coppens K. 2005).
Improvement Team of Papageorgiou Hospital
The name of the team is inspired from the philosophy of Kaizen (Kai = change, Zen = good) and there is a clear influence of a Japanese organisational model as philosophy and practice. The main element of the group culture is the pursuit of continuous improvement that leads to excellence. This means many small, fast and steady improvements with the overall participation of employees, from managers to ordinary staff.
This team acts as a "quality circle" and comprises different employees (cross- functional team) who have different knowledge and skills. Its aim is to solve complex interdisciplinary problems involving employees from all departments and to implement of proposals for improving the daily functioning of the hospital.
Through the technique of brainstorming, each team member submits new proposals and ideas for evaluation, discussion, processing, approval or rejection, aiming for the continuous improvement of processes and labour standards.
Solutions are proposed, whether simple or innovative, regarding procedures, planning, technology, or whatever else contributes to improve the effectiveness, efficiency and quality of services provided in Papageorgiou Hospital. But the most important thing is that they arise from employees of the first line, adding value to their work and exempting them from the "garbage" activities. Nothing is imposed from "top" to "below", but essentially ideas are suggested by the staff that cope with the problems on a daily basis and therefore, have full knowledge of the issue.
Kaizen means improvement-change for the better. It includes small steady steps for long periods, with minimal cost. Any change for the better is a strategy, a philosophy that runs throughout the structure of the organisation.
It is a long road to improvement, that must be followed by all employees, with common concepts and a team spirit, a journey without end that leads to excellence.
The employees participating effectively in improving processes collect benefits and optimise unexploited potential while through these actions, unnecessary handling is reduced (“the garbage”, according to Kaizen concept) saving resources and improving efficiency.
The Continuous Improvement Team represents a pioneering creative energy management in a Greek Public Hospital. During the short time it has been operating, it has solved several major and minor problems, by endeavoring continuous efforts for continuous improvement of the everyday work.
Problems the Kaizen Method Has Solved at the Papageorgiou Hospital
Department Rules and Regulations: Regulation manuals have been issued for various departments (such as Surgery, Oncology, Emergency e tc.). Working g roups have been appointed to ensure that all rules are properly implemented.
Oncology department: Reduction of time of patients’ stays, acceleration of all laboratory procedures, improving patient quality.
Reducing Bureaucracy: Improvement and replacement of bureaucratic procedures, resulted in increasing employee productivity. “Best practices” have been implicated under SAP ERP system. “One stop patient service” has been established.
Go Green: Implementation of proposals concerning energy and resources. Organisation of staff training and awareness actions and Eco-Week event.
Reduction in the number of laboratory and imaging examinations: Use of repeat testing interval international guidelines and staff training and awareness actions
• Continuous Improvement through the philosophy that everything can always be better
• Kaizen is Japanese word meaning 'change' and 'good'
• Focusing on the qualitative rather than quantitative motivates staff
• Kaizen is based on multidisciplinary collaboration