Gemba is Japanese for “the actual place” and a gemba walk involves understanding what is happening in an organization by going to the specific spot where work happens.

By Denise Scott

The first article in this two-part series shared how to build engagement and alignment in your community through a gemba walk. Gemba is Japanese for “the actual place” and a gemba walk involves understanding what is happening in an organization by going to the specific spot where work happens — the resident room, the medication room, the kitchen, the central laundry.

Go See

Watch. Listen. When considering the work, look at purpose (why is the work happening?), process (what is happening?) and people (who is involved?). Is the work aligned with what residents expect? Are processes following designed specifications? Are people actively engaged in the work?

The place of work is a socio-technical system. That is, it is made up of people and tasks that combine to produce the results achieved. That’s why it’s crucial to understand both processes and people to determine how aligned to the purpose the work is.

You may wonder where you can find the time to go and see the work being done. After all, you are probably busy filling out reports, reviewing incident logs, responding to family questions and employee complaints, and a sundry of other crucial tasks. The short answer is right now. Most of the work currently consuming administrators and long term care leaders is retrospective analysis and oversight of work. Sometimes, whole days are spent just reviewing what has already happened and whole committees sit around debating why.

To start, just try spending 15 minutes a day watching work. You can even do small tasks to ease your way into the work areas of line staff — particularly if they aren’t used to you being there. Review the MAR at the med cart, sit in the dining room and have lunch with residents, chop onions in the kitchen, mop a resident’s floor, fold laundry. The key is to be present where the work occurs.

Ask Why

When you go to the place of work, you will find things you don’t understand or are different than you expect them to be. Resist the urge to correct the staff member or remind them of a particular policy or procedure. Instead, find out why the person is doing the work the way that they are. If a shortcut is being used, challenge the person to understand why the shortcut is used rather than resolving the underlying issue. By digging deep, you will see how small problems snowball into bigger ones through our natural tendency to quickly address issues in the course of work rather than study the problem and attempt to resolve the underlying causes.

In addition to (hopefully) many good things, you will likely see the following happen: staff running back and forth to find supplies; employees running into problems; residents unhappy about policies; equipment broken or used improperly; staff taking shortcuts. Employees may also ask you what to do when they encounter an issue. Resist the urge to solve their problem. Rather than take the issue back to your office to fix, or quickly implement your own solution (even if you “know” it to be correct), take the time to work through the process of problem solving with individuals and small teams.

When teaching staff, it’s important to balance challenging with coaching. You want to push employees to think critically about issues, but you don’t want them to become frustrated and disengage.

At the beginning of this process, staff will likely respond to many questions by saying, “We didn’t know we could do that,” especially if the community has history of authoritarian-style leadership. It can take some time, but once staff understand that they are trusted and able to solve problems and enact changes, most will never want to go back to the old way of doing things.

By providing support, empowering teams to learn about and improve their own work, and actively listening to challenges, you build a robust and capable workforce that looks forward to management presence rather than scurrying at the footsteps of the administrator.

Show Respect

Showing respect for staff cannot be overstated. Work in this field is extremely hard, both physically and emotionally, and it’s important to constantly recognize the contributions each team member makes. When you are in someone’s work area, be sure to introduce yourself and explain why you are there. No one wants to work while feeling like they are being judged.

Listen. Listen to what employees say and refrain from judgments or quick solutions. Lean teachers can oftentimes fix problems faster than individual employees, but they recognize that they can’t be everywhere at all times. Thus, it’s more crucial to develop problem-solving thinking in each person. Remember, Lean is about ordinary people working with extraordinary processes to get great results.

Finally, and once again, don’t blame employees for doing work a certain way, even if it’s wrong or against policy. Find out why they are doing it that way. Most people don’t purposefully do the wrong thing. Asking why something is happening a certain way provides an opportunity to get at the heart of challenges and begin implementing sustainable improvements rather than temporary band-aids.

Sean Carey, MHA, LNHA, CDM helps organizations improve performance, align resources, implement technology and innovate current practices. He is the author of Lean for Long-Term Care and Aging Services: A Practical Guide for Driving Improvement, Engagement and Resident-Centered Service.  In addition to hands-on experience learning, implementing, and practicing Lean, Sean has Green and Purple Belt Lean Six Sigma training. If you are interested in learning how Sean can improve your organization’s outcomes contact [email protected].