Kaizen Huddle Boards Empower Nurses to Improve Efficiency, Care

Joni Watson, MSN, MBA, RN, OCN

Like most in their profession, nurses at the Baylor Scott & White Cancer Center (BSWCC) do a lot of walking each day.

For a long time, those who work in the infusion pod had the particular burden of having to leave their pod whenever they needed to get a pair of gloves, taking an estimated 25 extra steps for each trip and additional time away from the patient.

Today, thanks to the center’s newly implemented huddle board system, those extra steps have been eliminated. The glove supply was relocated to a more efficient location.

Huddle boards—permanent bulletin boards that display daily status and improvement plans for a workgroup—are part of the Kaizen lean production method, a rapid improvement initiative designed for businesses and spearheaded by Toyota. Every day or in some cases every shift, team members “huddle” or meet at the boards to identify problems, track them, and immediately implement changes.

Following the Kaizen method (which translates to change for the better in Japanese), the BSWCC has seen significant improvement, implementing hundreds of positive changes over the past year, said Joni L. Watson, MBA, MSN, RN, OCN, director at the BSWCC, which is located in Waco, TX.

“We’ve had 300 ideas generated in the last year and we have tried at least 80% of those ideas,” said Watson during a recent interview at the ONS Annual Congress where she presented her research on the program.

“They have made a tremendous impact on our cancer center, reducing waiting times, making sure patients arrive on time, enhancing safety measures, generating new financial resources for patients in the community, and much, much more.”

The key to the Kaizen huddle board method is that every team member contributes ideas and takes charge of bringing their own ideas to life. The method is based on the understanding that frontline clinical leaders are the best individuals to identify gaps or duplicative elements within patient care.

At the BWCC, there are five huddle boards for frontline units, including one for the infusion team, the medical oncology team, the radiation oncology team, the front desk, and the supportive care team.

Each team’s huddle board generates approximately five to 10 ideas per month on average, said Watson. Everyone is involved, including nurses, respiratory therapists, radiation therapists, and physicians.

“Team members at the frontline really have the power to do rapid cycle continuous process improvement,” said Watson. “It is about team members looking at their own processes, looking at their own care and being empowered to make changes. Whoever generates the idea is the one responsible for implementing it, so there is not an undue burden on management to collect and implement all these ideas.”

That’s not to say that management is not involved. The administrative and executive branches have their own huddle boards as well. If a frontline team member has an idea that requires approval, assistance, or financial contributions from someone in management they can simply write that idea on the administrative or executive board. Every level within the hospital has a huddle board.

Most changes, like moving the glove box, seem small on their own, said Watson. But they add up.

“When you do it everyday, it doesn’t seem like a lot,” she said. “The changes seem small on a day-to-day basis. But when you put everything together it makes a tremendous impact.”

At BSWCC, they conducted monthly audits of the effectiveness of the huddle boards and redefined them based on their findings each month. Initial monthly audits indicated an overall 30% compliance with all team members huddling daily less than 25% of workdays.

With ongoing refinement, monthly huddle audits now routinely show 90% or greater compliance with necessary huddle board elements and team members are consistently huddling daily. Over 10 months, the BSWCC has seen rapid improvement in numerous areas including the identification of missed revenue opportunities, the development of in-house education programs and external education programs for team members, the creation of a patient assistance fund, the initiation of campus-wide cancer awareness events, a reduction in overtime, and increased department productivity.

Although there are many benefits, the overall goal of the program is really to improve patient care, said Watson.

“It all boils down to looking at the value for our patients, who are our customers, and eliminating the waste that is built into healthcare,” she said. “When we improve that value for our patients, it also frequently improves the experience for our team members.”