KAIZEN Theme

selection
Prepared by Francisco M. Chibunda
QIT SECRETARY

1
Introduction
KAIZEN-Theme selection is the first step,
among the seven steps of KAIZEN process of
solving the problems that exist in a
workplace which need to be taken by staffs
who want/wish to improve their Quality of
Services for clients.
Prepared by Raymond Dibogo

2
Definition of different terms
• Theme is Synonymous to subject, topic, idea, or subject matter.
• It is usually a broad statement of the problem.
• It’s usually encompassing statement.
• Problem is the gape between ideal condition and current
condition, knowing what should be but actually is not.

3
KAIZEN Process
KAIZEN process has seven steps called “Quality Control story”
which established in a sequential manner, named;

Step 7: Standardization of effective countermeasures

Step 6: Check effectiveness of the countermeasures

Step 5: Implementation of identified countermeasures

Step 4: Identification of countermeasure

Step 3 Root cause analysis

Step 2: Situation analysis

Step 1: Selection of KAIZEN Theme

How to select KAIZEN theme

•There are four main steps of KAIZEN them selection:-


Staff discussion on difficulties that staffs &clients are facing at work place daily .


Identifying some problems raised on the discussion based on data that shows the
gravity/seriousness of the problem to both internal and external clients.

-
.

5
Collect the possible suggestion aroused in the discussion based
on;
- Claims from internal & internal clients.
- Mistakes which are often happening.
- Un availability of material resource that disturbing
smooth practice of daily routine work.
-Working process that takes time & hard to do or finish.
Evaluating feasibility of each KAIZEN theme suggested, based
on given criteria's as follows.

6
Evaluation of feasibility of KAIZEN them

•Criteria for suggested KAIZEN are,

Impact. Examine the degree of impact when problem
reduced or solved.
Urgency. Examine if a theme has to be tackled
immediate or not.
Realization. Examine if the suggested theme if is possible to
be tackled with the available and existing
resources or not.
Burden to service users. Examine if it is of less burden to
service users.

7
• Key point need to be set and agreed upon, that the suggested
KAIZEN theme/ idea with high points will be selected.
Key
O stand for 2 points, + stand for 1 point,
X stand for 0 point.
• Observe an example of matrix table for KAIZEN theme selected
in certain ward.

8
 KAIZEN theme selection matrix
Possible theme Immediate Urgenc Realizatio Burden to Score
effect y n service
users
ward space
expanded
+ X + X 2
giving wrong
medication to
O O O + 7
7
patients is
reduced
sampling
mistake of
+ + O O 6
laboratory test
is reduced
medicine
wastage
O + + + 5
volume is
reduced
9
Key points
• KAIZEN-Theme selection need to be established on positive
wishes of staffs-example we would like to do…./to be….
• KAIZEN theme is not a permanent theme, should be
implemented within a short period of time, (approx 6 months).
• Should have grate impact.
• Does not require many resources and possible to realized.
• Presence of data's on all process done for selection of the theme.
• Availability of the explanation on why, and how KAIZEN
theme chosen.

10
Did you select good KAIZEN theme?
• Impact
• What is the impact, when it is implemented ？
• Is it possible to get impact with little inputs?
• Urgency
• Do we have to do it immediately?
• Possibility
• Is it possible to complete whole KAIZEN process in 6
months?
• Is it possible to carry out KAIZEN process within your
department?
• Are we not giving a burden to service users?
• Resources
• Possible to implement with existing resources ？
• Require involvement of many sections ？
• Is data and information available for situation analysis? If not available,
is it possible to collect ？
• Who and how many staff are going be involved?
 KAIZEN Step 2:
“Situation Analysis”
Objectives of the session
At the end of the session, trainees are able to:
1) Define what is situation analysis in KAIZEN process
2) Describe process of situation analysis
3) Describe how to develop and utilize Pareto chart properly
4) Demonstrate the process of situation analysis

14
KAIZEN STEP
Process 7 Standardization

STEP
Check effectiveness of countermeasure
6
STEP
5 Implementation of countermeasure

STEP
4 Identification of countermeasure

STEP
3 Root Cause Analysis

STEP
2 Situation Analysis
STEP
1 Selection of KAIZEN theme
15
Steps of situation analysis in KAIZEN
process

1 2 3 4 5 6 7
Identify
Define
measurab Develop
Identify methodol Conduct Develop
le data a
contributi ogies for data Pareto Set target
and calculatio
ng factors data collection chart
informati n table
collection
on

16
Steps of situation analysis (1)
1. Brainstorm to identify Contributing
factor 1 Contributing
factor 2
contributing factors of
the problem (KAIZEN
theme)

Contributing
factor 4 Contributing
“Large problem” is factor 3
composed of several
contributing factors
(composing elements).
Large Problem 17
Steps for Situation analysis (2)
2. Identify measurable data and information of each
identified contributing factor

3. Identify methodologies of the data collection;

- Period of data collection (maximum 1 months)
- Kinds and number of data source: retrospective data or
prospective data
- Collection method

18
Steps for Situation analysis (3)
4. Conduct data or information collection according
to the methodologies

5. Develop a calculation table of frequency and its

accumulation ratio to compile the data

19
Example of calculation table
KAIZEN Theme is “Giving wrong medication is reduced”
Before KAIZEN
SQ# Contributing factors Cumulative Accumulation
Frequency frequency ratio

1 Number of giving wrong 25 25 46%

injectable medicines

2 Number of giving wrong inhale 16 41 76%

medicines
3 Giving wrong oral medicines 6 47 87%
4 Giving wrong volume of insulin 5 52 96%
5 Number of giving wrong ointment 2 54 100%
　 Total 54 - -

Calculation formulas will be

Descending order explained on the next slide 20
Points of development of calculation table

• Contributing factors will be put in descending order of its frequency

• Cumulative frequency = (its frequency) + (the previous cumulative
frequency)
• Accumulation ratio = (each cumulative frequency) ÷ (Grand total of
frequency) × 100

Please see next slide!!

21
Steps for Situation analysis (4)
6. Develop “Pareto chart” based on the data table, to identify prior
contributing factor(s) to be solved

“Calculation table” “Pareto chart” 22

What is Pareto chart?
Cut off line is 80%
• It is a type of chart that 25 100.0

contains both bars and a 90.0

80.0
line graph, where 20 80.0

Accumulation ratio (%)

70.0
individual values are 15 60.0
represented in

Frequency
50.0
descending order by 10 40.0
bars, and the cumulative 30.0

total is represented by the 5 20.0

line 10.0
0 0.0
• One of the seven basic 1 2 3 4 5

tools of quality control

http://en.wikipedia.org/wiki/
Contributing factor
Frequency Accumulation ratio (%)
Pareto_chart
Example of Pareto chart 23
Pareto principle
• It is also called as “80:20
rule”
• It is a technique helps to
identify the top 20% that
needs to be addressed to
resolve the 80% of the
problems
Vilfredo Federico Damaso Pareto,
Italian economist, developed this
concept

24
Necessity of Pareto chart in KAIZEN Process
• To identify “large contributing factors”
• If the large contributing factor(s) is solved, the situation with the problems will be
improved effectively and easily
Reduced by
eliminated the
contributing
factor “1”

Problem

Contributing
factors

Situation with problems before Situation with problems after

KAIZEN (100% of the problem) KAIZEN (reduced problem) 25
 (Example) Data table and Pareto Chart
Maximum number of the axis shall match with
the frequency of the first faactor
Before KAIZEN

SQ Contributing factors
# Cumulative Accumulation Cut off line is 80%
Frequency frequency ratio 25 100.0
90.0
Number of giving 20 80.0
80.0

Accumulation ratio (%)

1 wrong injectable 25 25 46% 70.0
medicines
15 60.0

Frequency
Number of giving
2 wrong inhale 16 41 76% 50.0
medicines 10 40.0
3 Giving wrong oral 6 47 87% 30.0
medicines 5 20.0
4 Giving wrong 5 52 96% 10.0
volume of insulin
0 0.0
5 Number of giving 2 54 100% 1 2 3 4 5
wrong ointment
Total 54 - - Contributing factor
　 Frequency Accumulation ratio (%)

• Period of data collection: 31st January 2014 to

30th February 2014 (30 days)
• Data source: medication and treatment chart
Methodologies of data collection need
• Number of investigated patient (chart): 50 to be described clearly. 26
Target setting
• The last step of KAIZEN Step 2 is “target setting”
• “Desire” and “target” is different

We want to reduce 70% of the problem! This

is our “target of KAIZEN”

What is the reason of 70%

reduction of the problem??

……… We just want…

Is it just your desire?

It is important to explain the

reasons of your target setting.
27
Pareto rule can be useful for
targetIdeally,
setting80% of the problem
(vital few) is the target of
the KAIZEN based on
Pareto rule.
But it is
difficult…?!

In the example above, if your target is:

• “46% reduction of KAIZEN theme” it means to solve all of the 1st
contributing factor
• “87% reduction of KAIZEN theme” it means to solve all of the 1st, 2nd and
3rd contributing factors) 28
Cont.
Target setting Our target is to make “wrong
medication” zero by April 2016.
By when? By April 2016

Number of wrong
What?
medication

How? 46% reduction

* Do not forget: Need to consider “the problem is still

remained even if you achieve your target 29
STEP 3: ROOT CAUSE ANALYSIS
KAIZEN STEP
Process 7 Standardization

STEP
Check effectiveness of countermeasure
6
STEP
5 Implementation of countermeasure

STEP
4 Identification of countermeasure

STEP
3 Root Cause Analysis
STEP
2 Situation Analysis

STEP
1 Selection of KAIZEN theme
31
KAIZEN Step 2 and Step 3

1 2 1

3
4 2
5

Find root causes

Identify the contributing Prioritize the of the
factors contributing factor(s) to contributing
be solved factor(s)

KAIZEN Step 2 KAIZEN Step 3 32

Cause-Effect diagram
(Fishbone diagram)

Cause Cause

Effect

Cause Cause

• It is developed by Prof. Kaoru Ishikawa

• It connects “effect” and “cause(s)” systematically with line
• Clarification of relations between effect and cause(s)
33
Steps of root cause analysis (1)
• Put effect (= the major contributing factor) in the step 2 as ”head
of fish”; “Why (the contributing factor) happened?”
• Draw heavy line from left to the effect on the center; ”Backbone
of fish”

Why (the contributing

factor) happened?
35
Steps of root cause analysis (2)
• Seek and list up all possible causes for the effect (the
primary cause)
• Avoid to mention to things in terms of “recourse shortage”:
No money, No human resources, No materials etc.

List of the possible

causes

Why (the contributing Because ….

factor) happened?

36
Grouping of causes
• Human: knowledge, skills health conditions, physical
conditions etc.
• Soft: system, methodologies, mechanism etc.
• Hard: material, equipment, furniture, tools etc.
• Environment: facility environment (water supply,
electricity, smell, humidity etc.), working environment
(work space, accessibility of materials, arrangement
etc.)

37
Steps of root cause analysis (4)
• Narrow down cause(s) of each primary cause (the
secondary cause)
• Avoid to mention to things in terms of “resource
shortage”

Environment Human

Why (the contributing

factor) happened?
Hard (machine/equipment) Soft (System and methodology)
38
Steps of root cause analysis (5)
• Find out “root causes” by asking “Why it is
happening?” in enough time (recommended 5 times) for
each possible causes listed on primary branch, and
branch them into secondary, tertiary.

Human One Two

Why (the contributing factor)

Three
Make circle
clearly on it!

happened?
This is
Root Four
cause
Five times!!

39
Tips for developing Fishbone analysis
• Effect = Major contributing factor, which was
identified in Step 2
• Effect is not equals to “KAIZEN Theme”
• If two contributing factors account for 80% (Pareto
rule) in Step 2, you need to develop two fishbone
diagrams

40
Cont.
• Repeat “Why~? – Because~.” in 5 times
• Consider “your own work / work place” before
searching a cause of others
• Avoid blaming other sections; KAIZEN is for own
• Do not deny the opinions from other group members

41
Cont.
• Avoid mentioning “shortage of resources”; “No
money”, “No human resource”, “No material” etc.
• Your analysis is stopped
• Avoid to guess and assume the causes
• Use your experiences, knowledge and existing information
in your working place

42
 If root cause(s) are not identified
properly, any countermeasures
could not be come up…

The problem will

never be solved!!

43
 KAIZEN Step 4:
“Identification of countermeasure”
KAIZEN STEP
Process 7 Standardization

STEP
Check effectiveness of countermeasure
6
STEP
5 Implementation of countermeasure

STEP
4 Identification of countermeasure
STEP
3 Root Cause Analysis

STEP
2 Situation Analysis

STEP
1 Selection of KAIZEN theme
45
KAIZEN Step 3 and Step 4

Find out root Find out Identify realistic

causes of the countermeasures countermeasures in
contributing to solve our working
factor(s) the root causes situation/condition
QC tool: Tree diagram QC tool: Matrix diagram

KAIZEN Step 3 KAIZEN Step 4 46

Outline of how to make
Tree Diagram

1.Put all the identified root causes in Step 3 on left end

2.Brainstorm countermeasures with team members against identified each
root cause
• 1st line countermeasure
• Clarify ideal situation towards root cause
• Connect the line with each route cause systematically
• 2nd line countermeasure
• Discuss detailed activities to realize the 1st line countermeasure(s)
• If identified countermeasures are not clear, we can break them to 3rd line countermeasures

47
 Primary countermeasures
Root causes (1st line countermeasures)

Primary
countermeasures for
Root Cause 1 (a)
Root cause 1
Primary
countermeasures for
Route Cause 1 (b)
More than one primary
countermeasure can be
Primary come up with for one
countermeasures for root cause
Root Cause 2 (a)
Root cause 2
Primary
countermeasures for
Route Cause 2 (b)

Primary
Root cause 3 countermeasures for
Root Cause 3 (a)

48
 Primary (1st line) Secondary (2nd line)
Root causes countermeasures countermeasures

Primary
Root cause countermeasures for
Secondary countermeasure (a) for
primary countermeasure （ a)
1 Root cause 1 (a)

Secondary countermeasure (b) for

primary countermeasure （ a)

Primary
Secondary countermeasure (a) for
countermeasures for
primary countermeasure （ b)
Root cause 1 (b)

Primary
Root cause countermeasures for Secondary countermeasure (a) for
2 primary countermeasure （ a)
Root cause 2(a)

Secondary countermeasure (b) for

primary countermeasure （ a)

Primary
Secondary countermeasure (c) for
countermeasures for primary countermeasure （ a)
Root cause 2 (b)

Secondary countermeasure (b) for

primary countermeasure （ a)
49
 Primary (1st line) Secondary (2nd line) Tertiary …
Root causes countermeasures countermeasures

Primary
Root cause countermeasures for
Secondary countermeasure (a) for
primary countermeasure （ a)
1 Root cause 1 (a)

Secondary countermeasure (b) for

primary countermeasure （ a)

Primary
Secondary countermeasure (a) for
countermeasures for primary countermeasure （ b)
Root cause 1 (b)

Primary
Root cause countermeasures for Secondary countermeasure (a) for
2 primary countermeasure （ a)
Root cause 2(a)

Secondary countermeasure (b) for

primary countermeasure （ a)

Primary
Secondary countermeasure (c) for
countermeasures for primary countermeasure （ a)
Root cause 2 (b)

Secondary countermeasure (b) for

primary countermeasure （ a)
50
Matrix Diagram
• Matrix diagram is useful to
check feasibility of all the
final-line countermeasures
“Feasibility check” ……?
Can we implement the
countermeasures with our
available resources?
Impact by the
interventions?
51
 Items for feasibility check Scales for
feasibility check
Item What should be checked Scale Meanings
3 High priority, Easy
How is the positive impact of to do
Importance solving the problem? No 2 Moderate
negative impact?
1 Low priority,
How soon the problem need Difficult to do
Urgency to be tackled?
Is it possible to implement
Difficulty the countermeasures
technically easy or not?

Time How long does it take to

consumption solve the problem?

Are resources (human,

Resources materials, financial )
availability available for implementation
of countermeasures?
52
Example of Matrix Diagram
Countermeasures
Develop training material
Conduct TOT
Sort and Set
Develop M&E tool
Develop storage rules
Weekly monitoring
Weekly inventory
Scale
3 High priority, Easy to do
2 Moderate
Time Consumption
• Make a circle
Importance
Feasibility
availability
Difficultly
Resource
Urgency
on the score of
identified
feasible
countermeasur
3 3 1 1 1 9 es
3 2 1 2 1 9
3 2 3 2 2 12
3 3 2 3 2 13
3 3 2 1 2 11
3 3 1 2 2 11
Meanings
3 3 3 2 2 13
Countermeasures get “11 points
and/above in total out of 15 (>70%)” are 53
selected for implementation
It is necessary to clarify the scale and cut off point for feasibility check
Cut off=70%
Scale: Imp Urg diffi Ti Reso Fea
3= high priority, easy to implement orta enc cult me urce sibil
nce y y co avail ity
2= middle level priority ns abilit
1= low priority, difficult to implement um y
Secondary pti
Root cause Primary on
Countermeasures Countermeasures

Staff is not trained Training on handling Teaching material development 3 3 1 1 1 9

injectable
Conduct training 3 2 1 2 1 9
Conduct sort and
No proper storage Use labeling and color coding for
place
set of store
setting of injectable store 3 2 3 2 2 12

Develop M&E tool 3 2 2 2 1 10

No clear
regulation of Develop Develop regulation of injectable
storage of regulation store 3 3 2 1 2 11
injectable
Sensitize the regulation
3 3 1 2 2 11
No instructing Instruction from Coordinate with pharmacy and
develop check sheet 3 3 3 2 2 13
from pharmacy pharmacy

Training and dissemination 3 3 2 2 2 12

No clear hand
over of medicine Change system of
Develop handing over note and
handing over
checklist 3 3 3 2 2 13

Un clear order
sheet design
Redesign of order Improve order sheet with other 3 2 2 1 1 9 54
sheet department
Tips for identification of countermeasures
• Reflect all identified root causes in Step 3 to Tree Diagram
• Check whether detailed countermeasures are identified or not;
breakdown of countermeasures by the level of countermeasures

55
Cont.
• Consider effective usage of available resources;
• Avoid identifying countermeasures with “increase / put something
resources”
• Discuss countermeasures that can be implemented by your section
itself
• Check conflict of activities among identified countermeasures

56
 KAIZEN Step 5:
“Implementation of countermeasure”
KAIZEN STEP
Process 7 Standardization

STEP
Check effectiveness of countermeasure
6
STEP
5 Implementation of countermeasure

STEP
4 Identification of countermeasure

STEP
3 Root Cause Analysis

STEP
2 Situation Analysis

STEP
1 Selection of KAIZEN theme
58
 Process of Step 5:
Countermeasures Implementation
Step ４ Step 5

Importance

Difficulty
Action plan

Urgent

Total
development
with 5W1H

Sharing action plan with

section staff
CM 1 ◎ ◎ ○ 13
Sharing action plan with QIT

CM 2 ○ ▲ ▲ 9 Implement
countermeasures

CM 3 ○ ○ ◎ 11 Monitoring progress of
intervention

Check
Step 6
effectiveness
59
Cont.

• Implement ALL the countermeasures identified as feasible measures

in Step 4
• Develop an action plan and possible to complete the countermeasures
within one to three months
• Share the action plan with:
• All section staff (Participatory implementation)
• QIT (Seek technical inputs)
• Monitor progress of implementation of the countermeasures

60
 Time allocation for Step 5
• Remember “proper time allocation” for whole process
of KAIZEN is maximum ６ months
• Implementation of countermeasure must be done
within 2-3 months

KAIZEN KAIZEN KAIZEN KAIZEN KAIZEN KAIZEN

Process Process Process Process Process Process
Step 1 Step 3 Step 5 Step 5 Step 5 Step 6
Step 2 Step 4 Step 7

2 months 2 - 3 months 1 month 61

Benefit of development of
action plan
Developing a action plan with “5W1H” will be of
benefit to;
• Define detailed actions to implement the countermeasures
with “5W1H”
• Improve communication among section staff
• Unify the sense of purpose of the staff in implementation of
KAIZEN
• Simplify a progress monitoring

62
Clarification of “5W1H”
“5W1H” Clarification Example
Why we need to take this To strengthen stock
Why? countermeasure management of medicines

Who is the responsible person of the Ward in-charge and KAIEN

Who? countermeasure team
Timing or period (deadline) of the
When? countermeasure
By 27th of October 2015

Where? Place where the countermeasure taken At the ward

What is objective of the Rules and regulation of

What? countermeasure storage of the medicines

How do you do for the countermeasure

How? (action, verb)
Develop
63
Example of Action plan format
Counter measure Who What Where When Why How

Ward In- Storage rules Strengthen stock

Develop of storage rules At the
1 with pharmacists
charge, ward and
ward
By Dec. 01 management of Develop
pharmacist regulations the medicines

Checklist and Reduce

Develop checklist and WIT, Ward At the
2 handing over note In-charge
handing over
ward
By Dec. 15 miscommunicati Develop
note on among shifts

3 ……

4 ……

64
Monitoring a progress of the implementation
• Develop a monitoring checklist by clarifying:
• Date of monitoring
• Responsible person(s) of the monitoring
• Progress of monitoring
• Utilize the checklist
• Utilize the results of the monitoring
• Proper implementation: continue
• Delay of the implementation: re-plan and implement
• Impossible to implement: clarify the reasons of why not
implemented

65
Example of action plan
with progress checklist

Who checked
monitoring

Progress
Date of
Counter Who What Where When Why How
measures

1 …………
／

2 ………………
／

3 ……….
／

4 …………….
／

5 …………
Keys for
／ progress check
G: According the plan
D: Delay
N: Not implemented 66
Tips for successful implementation
• It needs to check again whether all countermeasures are
possible to be carried out within the section or not

• Remember “KAIZEN is participatory activities”

• “WHO” in your plan is not only “in-charge”
• Sharing the plan with all section staff

67
Cont.
• Action plan must be displayed on the notice board for
staff
• To remind staff of implementation of KAIZEN
• To promote participatory implementation of KAIZEN

• Conduct periodical monitoring with progress checklist

68
 KAIZEN Step 6 :
“Check effectiveness of countermeasure”
KAIZEN STEP
Process 7 Standardization

STEP Check effectiveness of

6 countermeasure
STEP
5 Implementation of countermeasure

STEP
4 Identification of countermeasure

STEP
3 Root Cause Analysis

STEP
2 Situation Analysis

STEP
1 Selection of KAIZEN theme
70
Outline of effectiveness check
1
Situation analysis

2 3
Effectiveness Relation between
check countermeasures and
- Reduction effectiveness
rate
- Comparison
Pareto chart

Implemented ・
Not implemented ・ Not effective
Not effective

Not implemented ・
But effective

Implemented ・
4 Effective
Go to Step 7: Standardization 71
How to check effectiveness of KAIZEN
• Compare frequency and reduction rate of frequency
between before and after KAIZEN
• Check achievement to your target set in Step 2 (reduction
rate)
• Compare other information in terms of:
• Cost
• Work labor
• cost effectiveness
• Quality
• Work process
• Human resource etc.
72
Data collection (Situation analysis after KAIZEN)

• Review methods of situation analysis done in KAIZEN Step 2

• Conduct situation analysis in the same methods:
• Same data
• Same period of data collection
• Same methodologies of data collection

73
Development of a comparison calculation table
Before KAIZEN After KAIZEN
Reduction of Reduction rate
SQ# Contributing factors Cumulative Accumulation Cumulative Accumulation
Frequency Frequency frequency (%)
frequency ratio (%) frequency ratio (%)
Number of giving wrong
1 25 25 46.3 7 7 46.7 18 72.0
injectable medicines
Number of giving wrong
2 16 41 75.9 4 11 73.3 12 75.0
inhale medicines
3 Giving wrong oral medicines 6 47 87.0 3 14 93.3 3 50.0
Giving wrong volume of
4 5 52 96.3 1 15 100 4 80.0
insulin
Number of giving wrong
5 2 54 100 0 15 100 2 100.0
ointment
　 Total 54 - - 15 - - 39 72.2

Data of before Data of after Reduction

KAIZEN KAIZEN between before
and after
KAIZEN
Formula of reduction rate

74
 Development of comparison Pareto chart
Adjusting scale as same level of before KAIZEN

25
Before KAIZEN 100.0 After KAIZEN
25 100.0
90.0 90.0
20 80.0
80.0 20 80.0
80.0
70.0 70.0

Accumulation ratio (%)

Accumulation ratio
15 60.0 15 60.0
Frequency

Frequency
50.0 50.0

10 40.0 10 40.0

30.0 30.0

5 20.0 5 20.0

10.0 10.0

0 0.0 0 0.0
1 2 3 4 5 1 2 3 4 5
Contributing factor Contributing factor
Frequency Accumulation ratio (%) Frequency Accumulation ratio (%)

Same order of “the contributing factors” between before and after KAIZEN
even if the order of contributing factors is changed. 75
 (Example) Comparison results between
before and after KAIZEN
Before KAIZEN After KAIZEN
Reduction of Reduction rate
SQ# Contributing factors Cumulative Accumulation Cumulative Accumulation frequency
Frequency Frequency (%)
frequency ratio (%) frequency ratio (%)
Number of giving wrong
1 25 25 46.3 7 7 46.7 18 72.0
injectable medicines
Number of giving wrong
2 16 41 75.9 4 11 73.3 12 75.0
inhale medicines
3 Giving wrong oral medicines 6 47 87.0 3 14 93.3 3 50.0
Giving wrong volume of
4 5 52 96.3 1 15 100 4 80.0
insulin
Number of giving wrong
5 2 54 100 0 15 100 2 100.0
ointment
　 Total 54 - - 15 - - 39 72.2
25 100.0
25 100.0
90.0 90.0
20 80.0 20 80.0

Accumulation ratio (%)

70.0

Accumulation ratio
70.0
15 60.0 15 60.0
Frequency

Frequency
50.0 50.0
10 40.0 10 40.0
30.0 30.0
5 20.0 5 20.0
10.0 10.0
0 0.0 0 0.0
1 2 3 4 5 1 2 3 4 5
Contributing factor Contributing factor
Frequency Accumulation ratio (%) Frequency Accumulation ratio (%) 76
 Breaking down your effectiveness
• Clarify whether each countermeasures were effective or
not
• Relation between countermeasures
and effectiveness can be categorized into 4 groups

Effectiveness
Effective Not effective

①　 ②
Implementation

Countermeasure
implemented It is effective and need to It is not effective and need
be standardized to review measures

Countermeasure not ③ ④
implemented Need to clarity why it is Implement some measures
effective (DO something)

77
Cont.
1. Effectiveness should be measured by each
countermeasure
2. The countermeasure that is not implemented but
show good effects need to be investigated the reason
3. The countermeasure that is not implemented and
cannot measure effectiveness need to be implemented

78
Cont.
3. It is necessary to review countermeasures if the
countermeasures were not effective
4. The countermeasures that were implemented and
judged as “effective” will be standardized in Step 7
5. The countermeasures may cause bad effects. If bad
effects are greater than effectiveness, it is necessary
to review the countermeasures

79
Identify effective countermeasures
Which countermeasure was
leading??
Your target
Move to KAIZEN
Achieved Step 7
Expected
outcome Partially
By doing the achieved
countermeasures
Got worse Review KAIZEN
Step 3, 4, 5, 6

Good effect
Unexpected Stop doing the
outcome countermeasure(s)
Bad effect

* Tangible effect, Intangible effect and Ripple effect will be also

recognized while Step 6. 80
KAIZEN Step 7 :
“Standardization”
KAIZEN STEP
Process 7
Standardization

STEP Check effectiveness of

6 countermeasure
STEP
5 Implementation of countermeasure

STEP
4 Identification of countermeasure

STEP
3 Root Cause Analysis

STEP
2 Situation Analysis

STEP
1 Selection of KAIZEN theme
82
KAIZEN Step 7: Standardization
• Prevent recurrence
Situation after of the problem
KAIZEN • Sustain “improved
situation”

Situation
before Standardize effective
KAIZEN countermeasures
Improvement

By effective
countermeasures

KAIZEN KAIZEN KAIZEN

Step 1 - 5 Step 6 Step 7 83
Standardization of effective countermeasures
• It is a part of the final step of KAIZEN process
• Two parts of standardization:
• Development of a implementation plan and its checklist
• Practice standardized activities sustainability
• Standardization measures must be able to
• Maintain the “good effects” by anyone in the workplace
• Eliminate waste continuously in costs and workloads

84
Benefits of standardization

• Reductions in variability
• Easier training of new operators
• Reductions in injuries and strain (ensuring safety for
internal / external clients)
• Baseline for improvement activities

Reference:
http://www.lean.org/Workshops/WorkshopDescription.cfm?WorkshopId=20 85
“Recurrence prevention” and “Standardization”
• “Prevention of recurrence” is not
equals to “standardization”
• Prevention of recurrence is to
prevent fallback of the improved
situation
• “Standardization” is very
important for proper recurrence
prevention

86
Process of standardization
1. List-up all effective countermeasures identified in
the previous step 6
2. Develop standardized procedure table by utilizing
“5W1H”
3. Develop “progress checklist” for standardized
implementation plan
4. Share the plan and checklist with all the staff in the
section

87
“5W1H” for standardization
5W1H Description

Why? Necessity of the standardized activity

Who? In-charge of the standardized activity

When? Period / Frequency of implementation of the standardized activity

Where? Place at where the standardized activity is taken place

Objectives of the implementation (verbs) or tools used for the

What? standardized activity

How? Methodology to carry out the standardized activity (verbs)

Note that the standardized procedure table is similar with implementation plan
in KAIZEN Step 5, however, there are different 88
Standardized procedure table
Standardized Why Who When Where What How
activities

Check stock To ensure stock In-charge of

condition of all management of stock Inventory
Daily Ward Use properly
medicines in our sampling management of checklist
section container the day

To reduce
miscommunicatio Before Handing
Check handing over n between staff All staff working taking over note
Ward Use properly
between shifts on reduction at the ward over next and
wrong shift checklist
medication

89
 Progress checklist

Standardized Checked
Progress Date of checking Remarks
action by

 Following
Check stock  Sustained
STD
condition of all
medicines in  Not
our section  Not following
sustained
STD

 Following
 Sustained
Check handing STD
over between
shifts  Not
 Not following
sustained
STD

90
Example of KAIZEN Step 7
Standardized Date of Checked
Why Who When Where What How Progress check Remarks
activities checking by

o o
Check stock To ensure stock In-charge of Sustained Following
condition of all management of stock Inventory Use STD
Daily Ward 　 　 　
medicines in our sampling management of checklist properly o
section container the day Not o
sustained Not following
STD

o o
To reduce Sustained Following
Before Handing
Check handing miscommunication All staff
taking over note Use STD
over between between staff on working at the Ward 　 　 　
over next and properly o
shifts reduction wrong ward
shift checklist Not o
medication
sustained Not following
STD

91
How to develop
progress checklist
• Establishing standardized methodology only does not
make sense
• It must be practiced by everyone in the workplace
• The checklist is important and useful tool to monitor
how staff are practicing, and the method is sustainable
• Progress check must be done frequently
• Period of monitoring must be agreed with the
workplace and shared with everyone

92
Tips for successful standardization
• Remember that KAIZEN should not be “individual
issue”, it should be “section issue”
• Try to avoided the situation of “only in-charge knows”
• Clarify roles and responsibilities of all the section staff in the
implementation plan
• Emphasize benefits by the standardized work process

93
Cont.
• Share the standardized procedures and its checklist with
all the staff in the section
• Consider and select effective ways for the sharing
• Display the standardized procedures on common place in the
section (eg. notice board)
• Disseminate how to use the checklist
• Put proper documents (ex. SOPs) in the place which the
procedures are practiced
• Remind the staff of the standardized procedure periodically (ex.
while morning meeting)
• Train the standardized procedures to newly employed staff and
students
94
Thank you