KAIZEN Record Sheet

(1) Please fill in all column on this entry sheet

(2) Please use this SHEET on "Total Record".

(3) Do not use and fill other SHEETs on "Step 1 to Step 7"

KAIZEN Theme

Hospital
Section

Problem Statement
(Please describe current situation and problem statement at yo

Step 1 KAIZEN Theme Selection

Date of starting implementation of Step 1

Possible KAIZEN Theme

1
2
3
4
5
6
7
8
9
10

Step 2 Situation analysis

Date of starting implementation of Step 2
Period of collecting information
Methods of data dollection

KAIZEN Theme
SQ#
 SQ#
Contributing factors
1
2
3
4
5
6
7
8
9
10
Total

Period of data collection (Date / Month / Year)

Data source
Method of data collection (e.g. interview, review do
questionnaire etc.)

Step 3 Root cause analysis

Date of starting implementation of Step 3
1
Root caurse
Root caurse
2
Root caurse
 Root caurse

Step 4 Countermeasuers identification

Date of starting implementation of Step 4

1
Root cuases

4
5

10
 11

12

Step 5 Implementation of Countermeasuers

Date of starting implementation of Step 5

Counter Measures

Example Develop of storage rules with pharmacists

1
2
3
 4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Step 6 Effectiveness check

Date of starting implementation of Step 6

Period of data collection (Date / Month / Year)

Data source
Method of data collection (e.g. interview, review documents, q
etc.)

KAIZEN Theme
SQ#
Contributing factors
1
2
3
4
5
6
7
8
9
10
Total

Before KAIZEN
12

10

6
 8

0
1 2 3 4 5 6 7

Note: Frequecy scale must be adjusted and mtach

Step 7 Standardization
Date of starting implementation of Step 7

Effective countermeasures
1
2
3
4
 5
6
7
8
9
10
11
12
13
14
15
to Step 7"

statement at your section)

 Immediate
Urgency
effect

Scoring scale Scoring scale

2= High effect 2= Very urget
1= Middle effect 1= Urgent
0=Low effect 0= Not urgent

Before KAIZEN
 Before KAIZEN (Cumulative
Frequency Frequency)
0
0
0
0
0
0
0
0
0
0
0
Descending order

th / Year)

iew, review documents,

 Soft (System)

Tertiary Secondary
Tertiary Secondary

Hard (Equipment)
 Soft (System)

Tertiary Secondary
Tertiary Secondary

Hard (Equipment)
1st line Countermeasures
suers

WHO WHEN
Ward In-charge and
By Dec.01
pharmacist
Before KAIZE
documents, questionnaire

Before KAIZEN
Before KAIZEN (Cumulative
Frequency Frequency)
0
0
0
0
0
0
0
0
0
0
0

100%

90%

80%

70%

60%

Before KAIZEN
50% Frequency
 70%

60%

Before KAIZEN
50% Frequency
Accumulation ratio
40%

30%

20%

10%

0%
6 7 8 9 10

ed and mtach with "Before KAIZEN" to see the reduction/improveme

Date of completion

WHAT WHY
 Date of completion

Burden to
Realization services
users/workers

Scoring scale Scoring scale

2= High possinility 2= High burden
1= Possible to implement 1= Middle burden
0= Difficult to implement 0=Low burden

Date of completion

EN
Accumulation ratio
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0!
Soft (System)

Primary
 Primary

rd (Equipment)
Soft (System)

Primary
 Primary

rd (Equipment)
 Date of completion

Countermeasures
 Date of completion

WHERE WHY
Strengthen stock
At the ward management of
medicines
 Date of completion

Before KAIZEN
EN After KAIZEN
After KAIZEN
Accumulation ratio
Frequency
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0

After KAIZEN
12

10

Before KAIZEN
Frequency 6
 8

Before KAIZEN
Frequency 6

Accumulation ratio

0
1 2 3 4 5

he reduction/improvement

WHO WHEN
KAIZEN Team members
 Score

0
0
0
0
0
0
0
0
0
0

on

12
12

10

0
1 2 3 4 5 6 7

Date of completion
Root caurse

Tertiary
 Tertiary

Root caurse
Root caurse

Tertiary
Tertiary

Working environment
2nd line Countermeasures
 WHAT HOW

Storage rules and regulation Write Strage rules

After KAIZEN
 After KAIZEN
(Cumulative Frequency) Accumulation ratio
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

1200%

1000%

800%

A
600% F
A
 800%

A
600% F
A

400%

200%

0%
3 4 5 6 7 8 9 10

Sustained 2
Moderate 1
Not Sustained, 0

WHRER HOW
EN Team members
100%

90%
 100%

90%

80%

70%

60%

Before KAIZEN
50% Frequency
Accumulation ratio

40%

30%

20%

10%

0%
5 6 7 8 9 10
 Life (Human)

Secondary Primary
Secondary Primary

Working environment
 Life (Human)

Secondary Primary
 Secondary Primary

king environment
Importance Urgency
Reduction of
Reduction rate
Frequency
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

1200%

1000%

800%

After KAIZEN
600% Frequency
Accumulation ratio
 800%

After KAIZEN
600% Frequency
Accumulation ratio

400%

200%

0%
10

Following STD 2
Moderate 1
Not following STD 0
Following
Implementation Score
STD
status
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Before KAIZEN
Frequency
Accumulation ratio
an)

Contibuting factors to solve

Contibuting factors to solve
Difficulty Time Resource Feasibility
consumption availablity score

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0
Date
3

Root caurse
Root caurse
4

Root caurse
Root caurse
 Soft (System)

Tertiary Secondary
Tertiary Secondary

Hard (Equipment)
 Soft (System)

Tertiary Secondary
Tertiary Secondary

Hard (Equipment)
2
Root cuases

4
5

10
11

12
oft (System) Root caurse

Primary
 Primary

d (Equipment) Root caurse

oft (System)

Root caurse

Primary
Primary

Root caurse
1st line Countermeasures
 Life (Human)

Tertiary Secondary Primary

Tertiary Secondary Primary

Working environment
 Life (Human)

Tertiary Secondary Primary

Tertiary Secondary Primary

Working environment
2nd line Countermeasures
Contibuting factors to solve
Contibuting factors to solve
Importa Urgency Difficulty Time
nce consumption
Resource Feasibility
availablity score

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0
KAIZEN Case Record Sheet

KAIZEN Theme 0
Hospital 0 KAIZEN Team members
Section 0

Problem Statement
(Please describe current situation and problem statement at your section)_x000D_

Step 1 KAIZEN Theme Selection

Date of starting implementation of Step 1 0 Date of completion 0

Burden to
Immediate
Possible KAIZEN Theme effect
Urgency Realization services Score
users/workers
1 0 0 0 0 0 0
2 0 0 0 0 0 0
3 0 0 0 0 0 0
4 0 0 0 0 0 0
5 0 0 0 0 0 0
6 0 0 0 0 0 0
7 0 0 0 0 0 0
8 0 0 0 0 0 0
9 0 0 0 0 0 0
10 0 0 0 0 0 0
Scoring scale Scoring scale Scoring scale Scoring scale
2= High effect 2= Very urget 2= High 2= High burden
1= Middle 1= Urgent possinility 1= Middle burden
effect 0= Not urgent 1= Possible to 0=Low burden
0=Low effect implement
0= Difficult to
implement
 0
KAIZEN Team members 0
0
Step 2 Situation analysis
Date of starting implementation of Step 2 0 Date of completion 0

Period of collecting information 0

Methods of data dollection 0

KAIZEN Theme Before KAIZEN

SQ# Before KAIZEN (Cumulative Accumulation 12
Contributing factors Frequency Frequency) ratio
1 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 #DIV/0! #DIV/0! 10
3 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 #DIV/0! #DIV/0!
8
5 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 #DIV/0! #DIV/0!
6
8 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 #DIV/0! #DIV/0! 4
Total 0 #DIV/0!
Descending order
2
Period of data collection (Date / Month / Year) 0
Data source 0
0
Method of data collection (e.g. interview, review documents, 1 2 3 4 5 6 7 8 9
0
questionnaire etc.)
 100%

90%

80%

70% Before
KAIZEN
Freque
60% ncy

Accum
50% ulation
ratio
40%

30%

20%

10%

0%
4 5 6 7 8 9 10
Step 3 Root cause analysis
Date of starting
Date of completion
implementation of Step 3

1
Root caurse Soft (System) Root caurse

0 Tertiary Secondary Primary 0 Tertiary Secondary

0 0

0 0 0 0

0 0 0

0 0 0 0

0 0 0

0 0

_x000D__x000D_ _x000D__x000D_

_x000D_ 0 0
 _x000D_ _x000D__x000D_ 0 _x000D__x000D_

_x000D_ 0 0

_x000D_ _x000D__x000D_ 0 _x000D__x000D_

_x000D_ 0

_x000D_ Tertiary Secondary Primary 0 Tertiary Secondary

Root caurse Hard (Equipment) Root caurse Working environment

2
Root caurse Soft (System) Root caurse

0 Tertiary Secondary Primary 0 Tertiary Secondary

0 0

0 0 0 0

0 _x000D_ 0

0 0 0 0
 0 _x000D_ 0

0 0

_x000D_

0 0

0 0 0

0 0 0 0

0 0 0

0 0 0 0

0 0

0 Tertiary Secondary Primary 0 Tertiary Secondary

Root caurse Hard (Equipment) Root caurse Working environment

3
Root caurse Soft (System) Root caurse
_x000D_ Tertiary Secondary Primary _x000D_ Tertiary Secondary

0 0

_x000D_ 0 _x000D_ 0

0 _x000D_ 0

_x000D_ 0 _x000D_ 0

0 0 0

0 0

_x000D_

0 0

0 _x000D_ 0

_x000D_ 0 _x000D_ 0
 0 _x000D_ 0

_x000D_ 0 _x000D_ 0

0 0

_x000D_ Tertiary Secondary Primary _x000D_ Tertiary Secondary

Root caurse Hard (Equipment) Root caurse Working environment

4
Soft (System) Life (Human)
Root caurse Root caurse
_x000D_ Tertiary Secondary Primary _x000D_ Tertiary Secondary

0 0

_x000D_ 0 _x000D_ 0

0 _x000D_ 0
_x000D_ 0 _x000D_ 0

0 _x000D_ 0

0 0

_x000D_

_x000D_

0 0

0 _x000D_ 0

_x000D_ 0 _x000D_ 0

0 _x000D_ 0

_x000D_ 0 _x000D_ 0

0 0

_x000D_ Tertiary Secondary Primary Tertiary Secondary

_x000D_
Root caurse Root caurse
Hard (Equipment) Working environment
Life (Human)

Primary

Contibuting factors to solve

0
 0

Primary

ng environment

Life (Human)

Primary

_x000D_
 _x000D_

_x000D_

Contibuting factors to solve

Primary

ng environment
Life (Human)
Primary

0
Contibuting factors to solve

0
 0

Primary
ng environment

Primary

_x000D_
_x000D_

_x000D_

Contibuting factors to solve

_x000D_

_x000D_

_x000D_

Primary
Step 4 Countermeasuers identification
Date of starting implementation of Step 4 0 Date of completion 0

1
Root cuases 1st line Countermeasures 2nd line Countermeasures

0
1 0 0 0
0
0

0
2 0 0 0
0
0
0
0
3 0 0 0
0
0

0
4 0 0 0
0
0
 0
5 0 0 0
0
0

0
6 0 0 0
0
0

0
7 0 0 0
0
0

0
8 0 0 0
0
0

0
9 0 0 0
0
0

0
10 0 0 0
 0
0

0
11 0 0 0
0
0

0
12 0 0 0
0
0
Importance Urgency Difficulty Time Resource Feasibility score
consumption availablity

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Step 5 Implementation of Countermeasuers
Date of starting implementation of Step 5 0 Date of completion

Counter Measures WHO WHEN WHERE WHY

1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
0

WHAT HOW
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
Step 6 Effectiveness check
Date of starting implementation of Step 6 0 Date of completion 0

Before KAIZEN After KAIZEN

Period of data collection (Date / Month / Year) 0 0
Data source 0 0
Method of data collection (e.g. interview, review documents, questionnaire 0 0
etc.)
KAIZEN Theme Before KAIZEN After KAIZEN
SQ# Before KAIZEN (Cumulative After KAIZEN (Cumulative
Contributing factors Accumulation ratio
Frequency Frequency) Frequency Frequency)
1 0 0 0 #DIV/0! 0 0
2 0 0 0 #DIV/0! 0 0
3 0 0 0 #DIV/0! 0 0
4 0 0 0 #DIV/0! 0 0
5 0 0 0 #DIV/0! 0 0
6 0 0 0 #DIV/0! 0 0
7 0 0 0 #DIV/0! 0 0
8 0 0 0 #DIV/0! 0 0
9 0 0 0 #DIV/0! 0 0
10 0 0 0 #DIV/0! 0 0
Total 0 0

Before KAIZEN After KAIZEN

12 100% 12

90%
10 10
80%

70%
8 8
60%
12 100% 12

90%
10 10
80%

70%
8 8
60%

6 50% Before 6
KAIZEN
40% Frequency
4 4
30% Accumulatio
n ratio
20%
2 2
10%

0 0% 0
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10

Note: Frequecy scale must be adjusted and mtach with "Before KAIZEN" to see the reduction/improvement
 0

After KAIZEN
0
0
0

KAIZEN
Reduction of
Reduction rate
Accumulation ratio Frequency

#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!

1200%

1000%

800%
 1200%

1000%

800%

600% After KAIZEN

Frequency

400% Accumulatio
n ratio

200%

0%
5 6 7 8 9 10
Step 7 Standardization
Date of starting
Date of completion
implementation of Step 7 0 0

Effective countermeasures WHAT WHY WHO

10 0 0 0
20 0 0 0
30 0 0 0
40 0 0 0
50 0 0 0
60 0 0 0
70 0 0 0
80 0 0 0
90 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
 Sustained 2 Following STD 2
Moderate 1 Moderate 1
Not Sustained, 0 Not following STD 0

Following
Implementation STD
WHEN WHRER HOW
status

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0