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"Gemba," is a Japanese word which means the "the real place" and in industry it has come to represent the ‘place where value is created.’ So in healthcare, going to the Gemba means spending time where the patients are, on wards, in clinics or even at the patient’s bedside where the real work of healthcare takes place.

Going to the Gemba is a key part of being a leader and healthcare manager. It is based on the principal that problems are not solved by faceless managers in remote offices; instead one should get as close to the place where value is created, primarily to gain understanding. The fundamental purpose of going to the Gemba is to learn and understand. Only then can we start to create solutions.

From our experiences of working with healthcare providers across the world we see problems being ‘solved’ high up in the organisation’s hierarchy, in boardrooms and offices. Ultimately, ill-conceived solutions and strategies are forced down onto the workforce leading to alienation and further contributing to the overburden of staff with minimal improvement.

The commonest behaviour we see is the creation of unnecessary, mandatory paperwork that is forced onto the staff that has been implemented because of a lack of understanding or appreciation of what the staff actually do. All this does is it creates a complex audit trail that does not benefit patients, but exists purely to satisfy the anxieties of the organisation’s senior management. Healthcare is an extremely complex system and because of this making changes leads to unintentional consequences. Attempting to solve a problem based on ill-informed assumptions is likely to lead to change, but not necessarily improvement. If you do not understand what actually happens at a patient level how can you propose a meaningful solution?

Healthcare professionals are trained in solving problems. Our instincts are to make things better and rescue people. However, we have to resist jumping to solutions and spend time learning and understanding. So rather than spending most of our times in meetings we should spend our time at the Gemba.

Being a successful organisation relies on having an understanding of what happens at the Gemba. This is the core business of healthcare – healthcare is about patients, not meetings. Neglecting the core business is the easiest way to make an organisation fail. Consequently, healthcare managers should aim to be operational (at the Gemba) instead of administrative (in offices and meetings) as much as possible.

Visiting the Gemba should not be akin to a ‘Royal Visit,’ where senior staff walk around departments waving at people and blessing the workers by spending time with them. Neither should it be a spying trip to see what the troops are up to. Instead, visiting the Gemba should be steeped in humility, where the executives acknowledge they are not the experts and they are there to learn. Toyota Chairman Fujio Cho summed up going to the Gemba as "Go see, learn what happens, ask why and show respect."

Respect is a crucial behaviour when visiting the Gemba. Fundamentally, showing respect for the workforce is the best way of motivating them. In addition, visiting the Gemba allows one to see firsthand the three key areas of inefficiency:
  • Wastefulness
  • Overburdened staff
  • Variation

Understanding how these three things directly impact on patient care is the key to solving almost every problem we encounter in healthcare. However, it takes more than understanding as respect also means once we have identified a problem we do whatever we can to resolve it.

So, next time you are sitting in a meeting and find the people around the table trying to solve a problem encourage everyone to get up and go to the Gemba. Before jumping to conclusions, get to know your workforce and go and see what is happening with your own eyes. Seek understanding and observe any of the 3 inefficiencies. This valuable information will enable you to work with your team to create a much more appropriate and credible solution. Visiting the Gemba is so empowering and is one of the most important principles and practices of good leadership.

By Dr Paul Jarvis