In a Lean Healthcare transformation, as problems are identified and the right tools are chosen to improve the problems, the right teams need to be selected to design and implement effective solutions.  Today I want to focus on team construct for a popular, yet often incorrectly-used tool: Kaizen.

For most three- to five-day Kaizen, or rapid improvement, events, a team should have 6 to 12 cross functional members. They should be focused on a problem that impacts most if not all of the team members.  It should also include a team leader and a sponsor who ultimately own the results and ongoing implementation.

It is easy to want to over-size a team to include many participants to support a given project, but this can be just as detrimental to the success of the team as not having enough participants involved.  Teams that are too large or have an improper mix are difficult to keep engaged.  Members get frustrated or bored and end up disengaged, causing disruption and delay.  A poorly constructed or defined team will not have time to implement many identified improvements during the week and will probably lose momentum in the following days and weeks.

It falls upon your sponsor and team leader to ensure this common problem is avoided:

Sponsor: Champion the improvement activity.

Avoid selecting sponsors just to get more people involved in sponsorship.  The sponsor should own the process that needs to be improved or should be a customer or supplier of the problematic process.  Sponsors also provide many of the resources needed to support the improvement activity and have the most to gain by having the problem improved.

Sponsors can provide support by spending time with the team.  They should review the problem and goals for the project and follow-up to insure the team is not struggling to progress.  Some teams stifle themselves when developing solutions for fear that it will not be well received by either leadership or co-workers.  The sponsor should assist with alleviating their fear and urge them to try their ideas.

Here are some no-no’s:  I’ve seen sponsors review a team’s progress and publicly voice that an idea is “stupid.” I’ve also heard team members state, “I wish they would just tell us what the answer is and I will go do it.”  A good sponsor will not determine the solutions for the team but make them feel their ideas are of value.  This also promotes culture change and the spread of continuous improvement throughout the organization.

Team Leader: Implement and sustain the results of the improvement activity.

A team leader, identified by a sponsor, typically serves as a direct report to the sponsor.  The team leader must have direct responsibility for the specific process that is to be improved.

A good team leader participates in an entire event.  They listen more than talk, ask questions to understand issues and avoid telling the group what should be done.  They also delegate responsibility and coach the team to ensure the completion of action and communication plans. They are careful not to take on the majority of the action items.

Four to six weeks prior to the start of the event, the sponsor and team leader should agree on the initial scope for the event along with the expected goals and possible team composition.

Good team members actively participate throughout the week identifying problems and solutions.  They take responsibility to complete action items and support the team’s decisions on what solutions will be tested or implemented to co-workers outside the team.

When composing the team, avoid adding members based solely on their availability or perhaps because they are a commonly used, known “good team member.”  Also, minimize team members whose motivation is to learn about Lean in order to check a box on a performance evaluation.

The best tool I’ve found for building a team is SIPOC (Supplier-Input-Process-Output-Customer). It is a great planning tool since it identifies the beginning, end and scope of the project along with the suppliers and customers of the process.  It also reveals additional information related to the inputs and outputs of each step in the process.  The below example was developed to select team members for an event which was intended to reduce discharge delays on a specific nursing unit..  Team members were chosen from the functions circled in red.

Lean Healthcare SIPOC

Many representatives should be front-line staff of the process targeted for improvement since they best understand segments of the process and have experienced the problems first-hand.

Call on ad hoc team members as needed. These are staff that have limited interaction or responsibility with a process but may be able to provide information about a part of the problem.  Don’t make them sit through an entire event.

Avoid having team members who just need to understand the solutions being implemented.  They can be updated and provide input during the week with scheduled informal report outs.

Projects with right sized teams chosen using the SIPOC method with a good sponsor and leader will be the most effective at achieving sustainable improvements.


This week’s blog was written by Linda Duvall, Director with HPP.

Linda leads Lean Healthcare transformation engagements for HPP. She has nearly 30 years of experience in business leadership, program management and lean transformation.  Prior to joining HPP, she worked for Vanguard Health Systems as a process improvement specialist providing leadership and support for regional and hospital level process improvement teams.  Linda holds a Bachelor’s degree in Industrial Engineering from the University of Evansville.

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