Japanese Philosophy and EMR Implementation Work Hand-in-Hand

With thoughts and prayers headed towards our friends in Japan, I thought it would be a good time to focus on their contributions towards work flow and process analysis, the cornerstones of health care consulting and EMR implementation.  

As many of you know, EMR implementation is more than buying a software package and a few machines and hitting the ‘on' button.  Prior to any of these investments, there are processes and efficiencies that must be identified and implemented such that an office, group or hospital can maximize the use of EMR to improve patient outcomes.  Several organizational methodologies exist to conduct such analysis and implementation: Sigma 6, Lean Thinking, Deming Cycle, etc.  One specific Japanese philosophy, 5S,has received a lot of attention of late as we transition towards complete EMR implementation.

5S represents a philosophy built around the principles of building an efficient workplace with standardized work procedures.  The tenets of 5S involve simplifying, reducing waste and non-value activity while improving quality efficiency and safety.   There are five words that this philosophy is built around.  They include:

1. Sort (Seiri): elimination of wasteful items around the workplace.  To do so, a process called red tagging is completed in which a red tag is placed to identify any item that is wasteful around an office.  All red tagged items are then removed and put into a central area where they can be evaluated.  Such items that are unneeded are discarded while those with occasional use are moved and organized.  This process allows for valuable work space to be freed up and clutter to be removed.
2. Set in Order (Seiton): focuses on efficient and effective storage methods.  For any given item, one must ask him or herself: What do I need to do my job? Where should I locate this item? How many of this item do I need? All shared items should have a place where employees can find it (e.g. mop, stapler, etc.) Everything has a place.
3. Shine (Seiso): Having rid yourself of waste and set in order the remaining goods in the office space, cleaning those areas thoroughly shall be the next focus.  A daily scheduled follow-up cleaning will help with sustaining such improvements while ensuring the remaining goods are looked after and kept in their best order.
4. Standardize (Seiketsu): creating a system of standardized practices is the next part of the 5S philosophy.  All employees doing the same job should be able to switch to any station with the same function and reproduce the work task.  Involving employees to participate in the process will only help make them feel invested and increase compliance with new standards.  
5. Sustain (Shitsuke): literally means implement and achieve.   While humans are quite resistant to such change, this process can and will prove to be one of the most difficult to complete.  The tendency always is to revert back to “old ways.”  Employees should always be thinking about ways to improve the work place and processes; in the event that some sort of issue arises where an improvement can be made, one must review the first 4 S’s and how they relate to the new process prior to making the appropriate change.

While sticking to the 5S principles won’t guarantee the smoothest implementation, there are some great reminders of what it takes to make a system work.  As you continue to consider EMR implementation or a career as an Implementation Clinician, Informatics Specialist, and/or Clinical Consultant, understanding work flow, process analysis and process implementation should be your highest priority.  With your solid clinical background and this framework to help guide health care facilities to more efficient results, you will begin to understand what it takes to take on such a job.