LeanHealthcare_GembaRoundingDuring a recent Lean Healthcare training session, a participant remarked about how awkward and out of place their leadership seemed as they made rounds on nursing units.  I was instantly reminded of my own first experiences with rounding – something I would emotionally compare to the first day of high school.  Few times in our lives make us feel more conspicuous.

The concept of the Gemba walk is critical to leadership in Lean Healthcare.  This Lean take on rounding provides the opportunity to observe work first hand, identify problems, celebrate successes, demonstrate visible leadership and reiterate the message of the goals we expect to achieve.  As leaders we are the stewards of change within our organizations.  It is our obligation to keep our teams focused on a system that promotes continuous improvement. However, just knowing that getting out of our offices is the right thing to do doesn’t make those initial attempts any less awkward.

How can we transition from a rounding robot to a true Gemba walker?  Here are a few beginning steps:

  • Get comfortable: Remember that any new behavior feels awkward at first.  Just like Tiger Woods reinventing his golf swing – you are trying to improve your skills.  Some people are more natural at it than others but, with a little practice and preparation it will become second nature to you and to the areas you visit.  Do some homework before you arrive on a unit and understand what the staff does and what is important to them.  Recognize their knowledge and experience as you initiate a dialogue about the work they do.
  • Educate Staff: Before you go to Gemba, be sure the staff on the units you will be visiting are educated about the purpose of your rounds.  Attend a staff meeting or huddle prior to your first (or next) time through and explain what you hope to review as you walk the area.  Stress the importance of observation to Lean Healthcare.  Going to where the work is done allows us to identify barriers that hinder our ability to make the right work easier to do.  Identifying issues is the first step in a culture that fosters collaborative problem solving and continuous improvement.
  • Make messages memorable: Go to the unit armed with thoughts and questions that will make your visit meaningful:
    1. Review the metrics of the department’s (or organization’s) goals. How does actual performance compare to the target?  Celebrate successes and encourage ongoing efforts.
    2. What is working well?
    3. What are you struggling with?
    4. What are you doing about the obstacles you have identified?
    5. What do you need from me? How can I help you be successful?
  • Bring an ice breaker: Share a story about something you have learned on your walks.  Give examples of Lean Healthcare projects other areas are working on and make a point of recognizing those efforts.  Ask if they have a patient story to share.  I once brought a handful of hospital logo pens with me as I visited on third shift and was surprised how much folks appreciated them.  If you don’t have pens, never underestimate the power of candy.
  • Assure staff: Make certain front line staff understand that your visit is an opportunity for collaboration and never a punitive activity. Then uphold that promise by ensuring that issues raised are dealt with in the spirit of a Lean Healthcare environment – a blameless culture that involves those who do the work in the solutions that are generated.  Keep in mind, the first time someone gets in trouble for something you saw on your rounds will be the last time you are welcomed openly on a unit.

In the end, we all survived the first day of high school.  We learned a lot, met some good people, and even had some fun.   Transitioning from robotic rounding to true Gemba walks will bring the same rewards.


Today’s blog was written by Karen Kendall, RN, healthcare planner with HPP. Karen is a registered nurse with more than 30 years of healthcare experience in clinical and leadership roles. 

Before joining HPP, Karen led multi-disciplinary teams through operational and space planning and work redesign efforts which resulted in in significantly improved efficiency, patient satisfaction and employee engagement. She has extensive experience in campus master planning, equipment planning, and way-finding. She has also served in clinical and leadership roles in a variety of areas including invasive cardiovascular services, surgical services, and pediatrics. 

Karen holds a Bachelor of Science in Nursing degree as well as a Master of Healthcare Administration degree from Duke University.

Photo by Maura/cc by

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