Kaizen and the ‘accumulation of marginal gains’

Abstract

Sometimes new concepts and ideas can come from the most unexpected of quarters. Ad Gandhe (Portsmouth Queen Alexandra) recently started his argument in a debate on distal radius fractures with the concept of Kaizen. A word which may sound to you like it did to me, surprisingly familiar, having been brought into the English subconscious by David Brailsford, the TeamGB cycling coach. I was slightly surprised it had found its way onto an AO Advances course – but Ad gave some surprisingly good arguments as to why it is essential in surgery. The Japanese concept is that of ‘accumulation of margin gain’. The British Cycling Team used it with resounding success, as have Team Sky in the recent Tours. The concept is that whilst a small individual variable may make no difference to the overall outcome (say …