Published: 09/2025
A Gemba walk is a structured observational practice in which leaders and team members visit the actual place (Gemba) where clinical work occurs to gain a firsthand understanding of workflows, identify improvement opportunities, and foster a culture of continuous improvement. Gemba walks are commonly used in Lean Management, as they give leaders important insights into process waste and the front line’s ideas for eliminating these wastes. The Gemba walk includes real-time observation of clinical processes and staff engagement, with the goal of identifying system inefficiencies, safety concerns, or educational gaps. It emphasizes the importance of direct observation over assumptions or second-hand reports. Gemba walks may be scheduled as a component of a continuous performance improvement plan or employed as needed when quality or process issues are identified. Effective Gemba walks depend on front line personnel feeling safe to share their full perspectives (psychological safety) and nonjudgmental observation by the leader. Leaders should notify those invited of the goals before the walk is performed. Leaders should also prepare questions before the walk, observe rather than intervene and use active listening to maximize the value of the walk. Techniques such as the 5 Whys may be useful in identifying problems in the process and understanding root causes.
Example:
The Medical Director and Nursing Director of Labor and Delivery identify the day’s first scheduled cesarean starts an average of an hour late. They initiate weekly Gemba walks to better understand the current process and opportunities to improve performance. They communicate the goals for the walks with the staff and physicians in advance and prepare a set of potential questions. Their first walk begins at the hospital entrance at the time the patient is expected to arrive. The Directors then physically walk the path the patient will experience from arrival to incision. They observe all aspects of the process and seek to understand by interacting with all involved parties. In these conversations, staff, physicians, and patients are encouraged to identify problems and offer suggestions to improve the preoperative experience and flow. Those who identify problems are genuinely thanked. The Directors adjust the scope of future walks to capture firsthand insights on key areas at key times. These observations and conversations enable them to identify multiple factors that cause delays. They then begin working with the hospital’s and unit’s improvement teams to develop a new, streamlined process to try to improve the rate of on-time first case starts.
Additional Resources:
- Graban, M. (2016). Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement (3rd ed.). CRC Press.
- Curtis, Scott. “Gemba Walk: Meaning, Process and How to Implement.” https://www.twi-institute.com/gemba-walk/. Accessed 9.8.25.