Going to gemba is a basic principle of Continuous Performance Improvement (CPI) efforts at Children's. When you go to see the work for yourself, you better understand problems and their causes.

As leaders of our value stream efforts, Jennifer and Dr. Martin have been learning to see in this new way through Lean leadership training provided by our CPI Department.

As part of this training, they have gone to gemba several times, visiting different areas of Children's as well as the Boeing and the Genie manufacturing plants to see Lean in action and apply tools for making improvements.

"Now I have these new lenses on, and I'm able to see things I didn't see before that we can do to make life simpler for both our patients and staff," says Jennifer, our director of the Orthopedics value stream.

"I've learned to see the value of standardizing our work to give patients a seamless experience, taking out the bottlenecks and barriers they run into from scheduling, to a clinic visit, to having surgery, to being discharged," she explains.

Later this year, Jennifer and Dr. Martin will take the next step, traveling with several other Children's leaders involved in value stream efforts to participate in a special intensive two-week program in Japan.

Now you might ask, what do Boeing planes and Toyota cars have to do with caring for patients and families at Children's?

Both Jennifer and Dr. Martin feel that the experience of observing processes and flow at Boeing and Genie has given them a deeper understanding of what it takes to improve processes and remove the barriers that get in the way as patients and families receive care at Children's.

"When I went to the Genie plant, I applied all of the tools I had learned in my first Lean leadership training at Children's," says Dr. Martin, our director of Anesthesiology and Pain Medicine.

"It's a powerful learning experience because you are trying to improve a process that is completely foreign to you, with the workers on the floor and a sensei (an expert from Japan) challenging you to go further with your improvements. After you observe the principles in action in the manufacturing setting, you come back and try to apply them in your service setting."

At Children's we can learn a lot from companies like Boeing and Genie, which have made significant improvements by applying Lean principles. However, as we move on from specific "point" improvements to more focused value stream work, we will concentrate on Toyota's progress in more than 40 years of applying Lean principles in all of its work.

Four groups of people involved in value stream efforts at Children's will travel to Japan for training in 2007 and 2008. Approximately 80 people will participate, including board members, faculty and executive leaders, and staff members.

Like Jennifer and Dr. Martin, all of the participants have completed Lean leadership training at Children's and have been deeply involved in process improvements.

"I've come to realize that the longer an institution has been on the Lean journey, the better they are at applying all of the tools," says Dr. Martin. "I've talked to people who have gone to Japan to learn about Lean, and they come back in shock about what has been achieved after applying those principles year after year."

While in Japan, each person from Children's will have the opportunity to improve processes on factory assembly lines. They will also present current and future Children's value stream maps to Japanese senseis and receive coaching on how to improve their future state designs.

When they return, they will be able to share what they have learned and collaborate with other Children's staff members in order to improve the experience of patients and families.

"From talking to parents of patients at Children's, I can hear their frustrations," says Jennifer. "They have to provide support to their children, and at the same time, navigate our difficult processes.

Our goal is to apply Lean principles to create a culture that will reduce waste, prevent errors and minimize the challenges. We want to help parents focus on their children, instead of problems like a long wait for an appointment or a canceled surgery."