Engaging the C-suite to Advance
Pharmacy Practice
Providing quality patient care through
progressive pharmacy practice
Driving Quality with Visual
Management
Samuel Calabrese, R.Ph., M.B.A., FASHP
Associate Chief Pharmacy Officer
Cleveland Clinic
Cleveland, OH
Objectives
• Identify various operational and clinical
metrics to provide consistency
• Describe ways to interpret data within
dashboard
• Identify methods for incorporating visual
management into daily tasks
Visual Management
The placement in plain view of all tools,
parts, production activities, and
indicators of production system
performance, so the status of the
system can be understood at a glance
by everyone involved
Make your workplace into a showcase that can be
understood by everyone at a glance. – Taiichi Ohno
Keeping it all Straight
• Visual Management
–
–
–
–
–
Prioritize work
Identify performance metrics
Identify if on/off target
Communication of standards
Provide real-time feedback
Cleveland Clinic Tools
• Monthly Review
• Daily Review
• Business intelligence
• Continuous
– Business Review Deck
improvement
– Quality Dashboard
activities
• Readmissions
• Huddles
• Core Measures
• HCAHPS
• Knowledge portal
Business Review Deck
• User defined Key Performance Metrics
– Benchmark
– Quality
– Financials
• Key Volume Indicators
– # of doses
– Just data: not necessarily benchmarked
• Top Projects
• Goals
– Have discussion
Standards should not be forced down from above but
rather set by the production workers themselves. –
Taiichi Ohno
Business Review Deck
• Development
– Two ½ day sessions
• Maintenance
– Refreshed monthly
• Review
– Monthly review using executive summary
• Opportunity to discuss issues with the team
Pharmacy Business Review Deck
Quality / Risk Management
Key Volume Indicators
Key Volumes
Quality Dashboard
Enterprise focus – with ability to drill
down
– Core Measures
• SCIP
– HCAHPS
– Readmissions
– Financials
MedBoard®
• Prioritizing work
– Stats visible
– Identifies items to be delivered
– Identifies items that have been waiting
– Identifies where product is within the
system
– Identifies final delivery location
– Communication tool for nursing
MedBoard Reporting
• Retrospective
– Turn-around times
– Identifies areas to focus on
• Real Time
– Where is the dose right now?
– Where was it delivered to?
May-June MedBoard Data
140
120
Delivery Time
On Cart Time
RPh Check to Cart Time
Rph Check Time
Prep Time
Verification Time
n= 6,496
n= 6,117
n=4,797
100
Median Time (in minutes)
Documented to Admin Time
49
n=1,078
50
n=851
n=1,156
n=1,159
80
n=4,946
56
60
13
2
13
28.5
42.5
35
35
35
20
0
7
3
5
6
4
5
9
4
4
7
4
4
12
11
3
2
17
17
6
3
4
6
4
4
35
57
61
n=12,004
3
40
50
n=12,584
6
1
n=3,688
n=3,856
20
5
3
3
11
6
1
8
6
1
9
13.5
8
7
5
3
3
6
6
7
7
6
1
8
1
5
4
27
2
4
Knowledge Portal
• Proactively manage automated
dispensing cabinets
– Inventory
– Controlled substances diversion
Knowledge Portal Home Screen
Knowledge Portal – Watch List
Pitfalls to reacting to colors
• Comparison group is inappropriate
• Patient acuity may be different
• Data could be corrupt
– Are all systems functioning as usual
– Did something change (Upgrades to
system?)
Dashboards give you a place to start
an investigation rather than an
endpoint
Team Based Visual Management
• Team accountability board
– Posted where work is actually done
– Content based on most important visual
information
– Updated daily
– Agenda for team huddles
– Allows for real times fixes
Pharm Culture of
Improvement
Nursing
Pharm Culture of
Improvement
Pharm Culture of
Improvement
Taussig
Phlebotomy
Leaders role in Visual Management
• Ensuring your team understands the
importance
– Not useful if not updated
– Accountability
• Using it
– What is your process to review
– Have team provide solutions when not
hitting target
Key Takeaways
• Visual management can assist in
managing overall business
• Visual Management tools can assist
in identifying areas needing
improvement
• Visual management can assist in
engaging employees in continuous
improvement
Reference
• Narusawa, Toshiko, and John Shook.
Kaizen Express, Fundamentals for
Your Lean Journey. Cambridge, MA:
Lean Enterprise Institute, Inc., 2009.
QUESTIONS