Using Leadership Kata to Achieve Key Results in Inpatient Admitting, Emergency Department Admitting and Outpatient Front Desk Processes

Kata, a Japanese word, can be used to describe a routine or pattern of behavior. At Virginia Mason, leadership kata is made up of the daily behaviors and activities that support the organization’s ability to create a culture of continuous improvement. As explained in Mike Rother’s book “Toyota Kata: Managing People for Improvement, Adaptiveness and Superior Results,” these behaviors can be separated into two distinct routines: improvement kata and coaching kata. Improvement kata uses the plan-do-study-act (PDSA) cycle to continuously improve. Coaching kata is used by leaders to coach and mentor frontline staff through the improvement kata (PDSA) — so that leaders act as problem framers rather than problem solvers.

Why is leadership kata important?

Leadership kata is reinforced by our world-class management system, and one component of this system is daily management. Leaders have daily standard work, which outlines specific behaviors and activities to be completed on a daily, weekly and monthly basis. In one of these activities, the daily huddle, leaders huddle with frontline staff at their production board to review metrics that provide a snapshot of the health of their business. The daily huddle reinforces the focus of both the improvement and coaching kata. As problems arise, leaders are expected to coach staff through the improvement kata to eliminate waste. The result of this is a culture of continuous improvement with a relentless focus on waste elimination in all levels of the organization.

“As problems arise, leaders are expected to coach staff through the improvement kata to eliminate waste. The result of this is a culture of continuous improvement with a relentless focus on waste elimination in all levels of the organization.”

– Erica Cumbee

Improvements in staff processes and costs

Since beginning this journey, Virginia Mason’s teams have achieved dramatic results in inpatient admitting, emergency department admitting and outpatient front desk processes.

The inpatient admitting team has seen total visit dollars holding for insurance verification go from a high of almost $6 million to a low of zero. For each day these unbilled dollars sit in holding, the total length of time increases for accounts receivable. Today the team is consistently keeping this number under $500,000 and using root-cause analysis when they begin to see results trend in the wrong direction.

The emergency department admitting team is using metrics to better inform coaching kata. One production board metric tracks the appropriate usage of standard work when scheduling follow-up appointments for patients prior to discharge. This metric has gone from consistently being under 50 percent to now consistently getting above 80 percent — and many times hitting 100 percent. This has enabled leadership to better understand which staff members need further coaching or training.

The outpatient front desk team has seen registration edits go from 577 encounters ($165,147) to now consistently reaching 0 encounters, which equates to no dollars holding. Through both the coaching and improvement kata, the team is now cross-trained and has a reliable process to eliminate these encounters in flow daily.

What are the benefits of practicing leadership kata routines? 

At Virginia Mason the benefits are clear:

  • Leadership kata drives continuous improvement. The teams are focused daily on waste elimination through the scientific improvement method of PDSA.
  • Documenting leadership kata aids in transition. As new leaders begin, documented kata provides them with an outline of expectations and key metrics they need to understand.

Leadership kata has a profound impact on culture. Daily leadership activities and behaviors either accelerate or stifle an organization’s ability to continuously improve. As you reflect on your own leadership kata, take a moment to document all of your current leadership behaviors and activities. As you review this list, ask yourself the following:

  • Does this leadership behavior or activity move my team closer to or further from continuously improving?
  • If the latter, what can I change today that will move me closer to the vision of continuous improvement?

Erica Cumbee, MPA, is a transformation sensei at Virginia Mason Institute. In Seattle and at client sites, she trains clients from all over the world to use lean tools and methods and helps them develop operational leadership, ensure adherence to lean principles and embed lean management methodology into health care cultures. Prior to joining Virginia Mason Institute, she led operations in patient financial and support services, developed health care curriculum for training, and coached leaders and staff through lean training and certification. Erica is certified in the Virginia Mason Production System®, experience-based design (EBD), training within industry (TWI) and focus group leadership.

Leave a Reply

Your email address will not be published. Required fields are marked *