Using Gemba Walks to Improve Staff Communication

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Improving communication across departments is often a key concern when discussing conflict areas in leadership programs. With increasing patient volumes, throughput within a facility can be a major pain point in facilitating timely admissions, discharges, and transfers. Nurse leaders admit that nurses drag their heels with ADTs because it adds to their workload. Not surprisingly, conflict occurs among the nursing staff involved in these ADTs. Often, there is little appreciation for what delays can mean. With the recent spikes in turnover, nurses no longer know other nurses working in the same hospital in other departments.

A creative emergency department manager recently discussed plans for her leadership project to improve throughput and nursing communication through Gemba Walks. A Gemba Walk is derived from the Japanese word “Gemba” or “Gembutsu,” which means “the real place,” so it is often literally defined as the act of seeing where the actual work happens. Walking a mile in someone else’s shoes can make a huge difference in understanding their point of view. The Gemba Walk is one of the most important principles of Kaizen, or the Japanese philosophy and methodology of continuous improvement. Traditionally, those doing Gemba Walks are in management and attempt to learn the processes through the eyes of those on the frontline. The purpose is to observe, understand, and ultimately improve processes. This initiative is unique because it is staff doing the Gemba Walk to learn processes in another department.

The project plan is to invite nurses from different hospital areas to do structured Gemba Walks in the emergency department, where they will receive guided tours from ED nursing staff. The Gemba walk will cover all the patient steps in the ED before admission and discuss the impact when patients are held in the ED for long periods waiting for beds. Throughout the Gemba walk, introductions will be made, and questions will be encouraged. Dashboard information about throughput is part of the tour, but the manager also plans to use patient stories to illustrate the discussed points. Nurses from the inpatient units will share their perspectives on the barriers they encounter as they accept admissions. The Gemba Walk will end with refreshments and some social time where everyone will debrief on what they learned.

This may seem like a small quality improvement project, but this manager is trying something different. She knows a key problem in staff communication today is that nurses no longer feel a sense of community in their teams and hospitals. Coming to understand each other through initiatives like the Gemba Walk is an important step to building bridges.

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