It doesn’t take long in lean circles to hear something along the lines of “Let’s go to gemba”, or “Let’s go and see.” This action of going to gemba is not only extremely effective in understanding what is actually happening versus what is thought to be happening – it also displays great respect for others. When we go to gemba, we are going to learn from the experts; the people in an organization that actually do the work.
But gemba walks are not just powerful when done within your own organization. I was reminded a couple of times this spring how enlightening and powerful visiting someone else’s organization with a gemba mindset is for those with all levels of experience with lean.
In one instance, I was visiting Palo Alto Medical Foundation in California. While discussing improvements in their primary care offices one of their physicians mentioned that they do a two-week look-ahead on their patient schedules. Two weeks! All I could think was, We often struggle to get an accurate picture of today and tomorrow, and they’re doing two weeks?! So clearly a two-week look-ahead was possible and doable – but now our team just needed to figure out how to get there in a meaningful way. We’re at work on that now.
In another example, IV pump availability has been a long point of frustration for our team at Washington Health System, and many efforts have been tried to improve our process. Even though we have more IV pumps than we have rooms, it often feels like we never seem to have one when and where we need it. In March we visited another healthcare organization in our region specifically to see how they handled IV pumps. Upon reviewing their practice, it became immediately obvious that they look at IV pumps almost exactly opposite of how we did. They focus on having IV pumps in their Emergency Department because that’s where most IVs are started; we were focused on trying to make sure we had the “right” amount of pumps on each and every unit. This little “a-ha moment” of perspective allowed us to make rapid progress, because it was the key learning we needed to make the rest of what we had learned and tried work. It seems fairly obvious now, but it took us seeing an unfamiliar gemba to be able to see the application in our own hospital. What I find most rewarding is that this opportunity to visit them was created because I personally extended an invitation to attend one of our Report-Outs to learn about a recent improvement one of our teams had completed. Everybody won.
After visiting various other organizations, all six members of my team had seen at least one new gemba, with the four least experienced having seen at least two new, all in a two-month period. The level of confidence, creativity, and energy in the overall team has been amplified by these experiences, and I wish we could do them more frequently. Visiting gembas is a key part of our organizational strategy, and it seems even more beneficial when we have several in a short period of time. It’s important to remember as well that visiting other gembas is especially valuable if done with an intent from both parties to share and learn equally. My experience has been if there isn’t mutual sharing, there is not as great a benefit for either party.
Going to gemba is perhaps the most basic form of lean training, and it’s one of the first things we teach our internal team members at Washington Health System when they start learning the principles. It’s also a large part of a lean organization’s culture – we often talk about tools, but we must remember they need to be used within a culture that encourages continuous learning and improvement. And finally, I’d be remiss if I didn’t remind everyone that lean is situational. What works for one organization may not necessarily work for yours.
And even if we get no solutions at all from a given visit, going to gemba takes us out of our element, from one where we think we know what is happening, to one where we may or may not have a clear understanding. Then as we gain the understanding, we find common challenges and opportunities. For less experienced lean practitioners, this often is reassuring that they are not alone in their struggles. For those with more experience, it’s often more of a reassurance that they aren’t crazy; they’re on the right track. In other words, you don’t necessarily need to walk out with a solution to have had a valuable gemba walk.
What’s the most memorable gemba visit you’ve been on? What strategies has your organization used to experience gembas at other organizations or to invite visitors to your gemba?