Kasey Schnebly, DNP: Moving Hospitalist Metrics Through Kata

Idara Nickelson

October 12th, 2017

I’ve had the pleasure of being an Adfinitas Health hospitalist at Meritus Medical Center in Hagerstown, MD for the past 5 years. During these 5 years I’ve had wonderful experiences with Lean through Kaizen events, A3s, 3Ps, etc. I have watched Meritus Medical Center take their quality goals by the reigns and start making things happen.  In early 2012, Meritus Health started their lean journey. There were many week-long kaizen events, which many of them I was personally involved in. In 2015, Toyota Kata was introduced to Meritus and completely changed the game.


Kata is a Japanese word that means a fixed routine that provides structure and creates a habit. “It is a practice routine that help us adopt new ways of acting and thinking.” One of the goals of Kata is to rewire the brain, keeping in mind that knowledge does not always mean understanding. As clinicians we know that neurons that fire together, wire together.  However, we do not always rewire correctly.


How did this help me as a hospitalist? In February 2017, I became the medical director of the observation unit at Meritus Health. The unit had a length of stay greater than 23 hours, and a monthly conversion rate of 30%. Bear in mind that the national benchmark for observation length of stay is 24 hours or less and the conversion rate is 20% or less. My challenge as a new director was to lower both metrics.


My first step was to review and understand the current state.  After data analysis, I learned that length of stay was 23.11 hours. I was not certain as to what obstacles were driving the length of stay, but I had some ideas. . I suspected that it was consultations from specialists but I was not certain. After extensive data collection and small steps in the right direction, as I learned through Kata, we uncovered challenges and created several educational tools and held various educational sessions for the staff. Within one month of our work, the length of stay dropped to 20 hours and the conversion rate dropped to 18 percent.


I’ve continued to make very small changes, tackling one obstacle at a time. I’ve been able to tailor the Kata to the needs of a hospitalist working a block schedule. Throughout my Kata, I was able to continue my clinical work and meet with my Kata coach for 15 minutes at a time to work on challenges.  Small changes make a big difference. While working through one obstacle, lots of other obstacles may also be overcome and metrics improve. Although my focus was only the observation unit at Meritus Medical Center, the education that I provided to my hospitalist team raised awareness of important clinical processes and protocols.


This month, I attended the Association of Manufacturing Excellence International Conference in Boston with the Operations Improvement Team from Meritus. The Meritus team gave a podium presentation that features some of the hospitalist-focused work being done using Kata. The presentation was well received and allowed for great conversation following the presentation. I also had the opportunity to see other presentations that I can apply within our practice. I was pleasantly surprised with how willing everyone was to share ideas and concepts-coining the phrase “steal shamelessly and make it yours” which I heard over and over. This was an amazing experience and I thank Adfinitas Health for the ongoing support and growth offered to all of their employees.


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