Gemba

I’ve learnt a new language this month. I’ve sat in countless high level meetings, and have just realised that I can now navigate discussions about strategy, forward views and corporate governance. Not to mention the acronyms I band about which can’t be found in the glossary of the Oxford Handbook of Medicine: KPIs, MOUs and AOB (progress on this front was aided by an email from my directorate manager with a useful attachment – the CQC Acronym Buster). I’ve even started talking about topics like strategic direction and engagement. Words which would have had me rolling my eyes and muttering "corporate mumbo-jumbo" a month ago.

I learnt a new word this week. Gemba. At first glance, I discounted the top google result as it told me that it was Japanese term meaning "the real place." To put that into context, Japanese detectives call a crime scene "gemba" and journalists may refer to themselves as reporting from "gemba". I’ve been at the Care Quality Commission for a month, having left "front-line" work as a medical registrar in a busy London teaching hospital to spend a year in the FMLM National Medical Director’s Clinical Fellow Scheme. I was invited to join a gemba in a personal email from my organisation’s Director of Quality Improvement (I was also glad that google hadn’t pointed me toward a new craze in exercise classes) and found there was more to the word than a factoid which may come in useful for the general knowledge crossword.

In business, gemba refers to the place where real work is done, where value is created. And as leaders and managers, it’s where we need to be to take the pulse of our organisation and achieve meaningful improvement. In healthcare, this is the frontline – the ward, the clinic, the waiting room. A "Gemba walk" connects the management to the frontline, in hospitals the "board to ward". Its all about observing, engaging and improving. It’s a key part of the Lean methodology for quality improvement which came from Toyota’s manufacturing line.

There’s a strong body of evidence from the Kings Fund that organisations with engaged staff have stronger financial management and better staff morale. However, they also deliver better patient experience, fewer errors and lower mortality. A CQC publication earlier this year into the state of our hospitals reported that many hospitals do not listen effectively to the views of their staff, which is having a major impact on their ability to provide safe, efficient, high-quality care. Engagement is the key to driving up quality in healthcare today. The only trusts which are achieving an "outstanding" rating are the ones where quality improvement is embedded in the culture of the organisation, where all staff are engaged and contribute to a process of continuous improvement. That’s a trust I want to work in.

This time next year I’ll be carrying the medical registrar bleep. But I’m confident that I’ll be returning to the gemba more equipped to engage, to build connections between ward and board, and drive up quality within a rapidly changing NHS.