Our members-only "gemba visits" are a core activity of the Healthcare Value Leaders Network. Two or three times per year, members of a Network gather for a two-day meeting at one of the member organization sites. These meetings are not focused on conference room talk and slide presentations - they are structured learning and interaction at the "gemba" (a Japanese term for the place where the work is actually done).

Each gemba visit is planned around a specific theme and learning objective to ensure that the visits are not an unstructured tour. Previous themes have included:

• Strategy deployment ("hoshin kanri")
• Management standard work
• How to spread lean through a hospital

The gemba visits are a way from the other Network members to learn from the host organization. The learning also goes in the other direction, as visiting Network members ask incisive questions and give constructive feedback. One manager at St. Boniface said they were pleased with how "respectful" the questions were, while being challenging at the same time. Network members try to walk the Lean talk.

Teaching comes from all levels of the host organization, from CEO to front-line staff. In recent visits, members have heard about both the challenges and the successes of the host organization. With the trust and relationships built within the Network, members can be open and honest about lessons learned instead of trying to put their best face on everything.

To keep the gemba visits to a manageable size, each Network has its own meetings. Typically, two or three people attend from each member organization, creating a group of 30 to 40 visitors. These teams break up into smaller groups to facilitate discussion and to interfere less with hospital operations.

Here are some member comments from our most recent gemba visit:

"The ownership by the St. Boniface employees was outstanding." Another noted that "there were many takeaways-- something for everyone... from the supply chain white board huddle, including employee suggestions, to communication in the value streams..." Members also found several other items of value, demonstrating the themes of spread and sustainment:

• The spread of surgical checklists.
• The outstanding peer-to-peer coaching process to sustain the changes after an improvement event.
• The senior leader mission control room, which included the prioritization of the lean support team's work.