The ED team completed a great first day in Nagoya, Japan. After a perfect flight from Seattle to Tokyo, a connector flight to Nagoya and an informational bus ride to Nagoya Central, the team settled in and prepared for a visit to Nagoya castle, which was built in the 1600s.

The visit was designed to enable individuals on each team to look at an unfamiliar area and process, collate their observations with each other and the other groups (OR and radiology), and relate those observations to our work environment and opportunities. This process was aided by sketching what we saw.

It was amazing to perceive the same area and structures in different and unique ways. While some focused on macro-structure, others saw the intricate design elements as their primary observations. Others saw the surrounding environment, while several individuals concentrated on the people involved. It reminded us of how we look at things through eyes and minds with diverse training and backgrounds, and often see different aspects of the same process, or the same picture in different ways.

A few of the major take home points for us included the following. Some noted that the visible structure is built and predicated on the infrastructure, which is intricate, but clearly thoughtfully planned and implemented. The solid structure of the castle walls reminded us that although the load bearing walls might be solid and uniform, the structure of the remainder of the walls was variable and unique, not unlike the multidisciplinary and unique individuals who make our institution function on a daily basis.

As we intently looked and sketched our areas, we were also reminded that first looks are indeed just that. We missed several key observations on those short assessments, reminding us of the need to go to the source often to experience the environment and learn, rather than look once and assume.

It was also obvious to us that although the surroundings were extensive and beautiful, they were somewhat overwhelming to us, even as tourists. We projected that feeling to how our patients and families might feel in our large and expansive facility. Although it is comforting to us as employees to work in a superb institution, it can be overwhelming and stressful for our patients and families, who not only have to contend with a new environment, but also manage the actualities of the illness, injury or other issue that has brought them to us.

It is our people who make the facility what it is and we are the ones who can make the building friendly and patient/family centric, as well as manage the medical concerns in a consistent, standard and quality fashion. As we viewed a facsimile model of several workers, connected by a rope and working in unison, who were tasked with moving a huge square building rock, it reminded us that the impossible and the unbelievable can be accomplished by teams that work together to provide safety, design a process and monitor results.

Together, working on the small as well as the large opportunities, we too can accomplish what might be thought of as impossible. Results might include service on demand with no waiting for care or interventions regardless of the time or day and medical processes without waste.

This has been a great first day of lean immersion and we are excited to continue our journey as CPI students and teachers. We look forward to sharing more information with you as we continue in Japan and upon our return.

May 31, 2008

The ED Team,
Dawn Cotter, Russ Migita, Kendra Powell, Amanda Mogg, Mark Del Beccaro, Cara Bailey, Connie Whillock and Tony Woodward