Daily Management
Visibility Wall Training
February 2013
Kaizen Promotion Office
Daily Management
The system used by the organization to
perform its daily activities by:
• establishing standard operations
Strategy
Deployment/ Hoshin
Kanri
• identifying and eliminating waste
• using data to ensure processes, products
and services are continuously improved
Daily
Management
Cross-Functional
Management
(DM)
(CFM)
Daily Management Link to Hoshin
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Daily Management Consists of:
1. A Visual Workplace where abnormalities are seen
2. An environment where staff test their own ideas
3. Transparency of objectives and metrics
4. Managing by measures that change regularly
5. Connects accountability throughout the organization
What you cannot see, you cannot manage!
Visual Management
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Respect for People
Staff are the problem-solvers:
Staff are a valued source for improvement ideas.
Staff help test and determine whether a new process works.
When errors occur, the process is wrong, not the person.
No blame, no shame!
Quality must be built into every step.
Anyone can, and is expected to, stop the process to prevent a defect from
continuing downstream.
“Before cars, make people.”
—Eiji Toyoda, former chairman of Toyota
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6
Visibility Levels
Strategic Visual Management
(Quarterly; Provincial Leaders )
Wall Walks
(Weekly - CEO
& SLT)
HOSHIN
KANRI
Hoshin 1
Q
C
D
S
M
Daily Visual Management
(Daily or Weekly; Manager and point of care staff)
Hoshin 2
Focus on a few strategic priorities;
align efforts to achieve breakthrough
improvement
Hoshin 3
Alignment
Strategic Visibility
(Hoshins)
BETTER CARE
3-5 Year Outcome Targets
0 Nosocomial
Infections
Target Progress
Wall Walk - QCDSM
why
Priority
Reduce infections
Chart updated as of ______
(recent!)
Action to be taken to
return to
VRE, MRSA, c.diff, ESBL
Hand Hygiene
compliance
Daily Visual
Management
LTC Site 1
LTC Site 3
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why
Why
LTC Site 2
CEO
why
Service Line Leader
why
why
LTC Site 4
8
Front Line Mgrs
You do not need to know Lean to get
started on Visual Daily Management
•It is critical to understand the current situation first before
using Lean
•Use 5 whys to get to the root causes and make improvements
•Use Plan, Do, Study, Act (PDSA) to do improvements
•As you learn Lean, you will make faster progress to achieving
your targets
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Elements of the Daily Management System
• Understand your business and daily improvement activities
• Create daily actions when issue/challenges occur.
• Data is classified into common categories on your unit’s
visibility wall – Quality, Cost, Delivery, Safety, Morale (QCDSM)
• Data and information is key:
-
Choice of data
Visual display and charts used
Method and frequency of collection determined
Method and frequency of reporting determined
Standardized Daily Management (DM)
Visibility Wall
• Primary processes drawn; sub-processes if needed.
Key support processes identified and drawn.
• Measures charted showing data and targets
• Team Schedule or huddle times
• Team communication – what is important to the team
• Improvement ideas – what are we testing - PDSA
• Who has responsibility for updating the measures?
• Who owns each measure – point of care person
Steps to creating a DM Visibility Wall
1. Articulate the Purpose Statement of the service area
•
E.g. Placement in LTC: place the patient in a LTC facility in a
timely manner that meets the patient’s needs.
2. Identify the primary process in your service area and draw a
value stream or process map
3. What are one or two measures that best describe how you are
meeting the core purpose?
•
E.g. Wait time for placement
•
Classify your measures under: Quality, Cost, Delivery, Safety,
Morale (QCDSM)
Steps to creating a DM Visibility Wall
4. Are there any other measures important to this key process?
•
E.g. Is resident wakeup checklist being followed by staff?
•
You don’t need measures for every primary process.
5. Create your Team Communications
•
What’s important for your team to know on a weekly basis?
•
When will you have your weekly huddles, weekly wall walks?
•
What other information are you going to post on your wall?
6. Improvement Ideas
•
Generate improvement ideas that will directly help improve what you
are measuring.
•
You can use Lean tools like Standard Work and 5S to help.
Purpose statement:
We are in business to…..
Team communication
Upcoming This
Week
Core Processes
Improvement
Team Calendar
•
•
•
•
•
Quality
Name
Cost
Date
Name
Delivery
Date
Example: improve Example: Reduce
wait time by 50% by OR supplies by
September 2013
20% by December
2013
Name
Example: Reduce
the wait list by
20% by February
2014
Name
• ~~~~~~~~
• ~~~~~~~~
5S
• ~~~~~~~~
• ~~~~~~~~
• ~~~~~~~~
• ~~~~~~~~
~~~~~~~~
~~~~~~~~
~~~~~~~~
~~~~~~~~
~~~~~~~~
Safety
Date
Standard Work
Improvement
ideas
Morale
Date
Name
Date
Example:
Example: Improve
Reduce surgical
attendance by 10%
site infections to 0 by July 2013
% by 2014
Purpose
Who are we from the patient’s
perspective?
Ask yourself – what makes you
come to work, what is the
department about/our
function, key reason for your
department/unit?
Quality
Measurement
Communications/Events
Improvement Ideas / Projects
Post what’s going on in the
Unit/department.
Area to post project forms –
Rapid Process Improvement
Workshop (RPIW), Value
Stream Maps (VSM), Sort,
Simplify, Sweep, Standardize
and Self-discipline (5S
projects).
Ensure the information is
Current and timely.
Landing spot for staff to post
Information.
Cost
Measurement
Example: improve Example: Reduce OR
wait time by 50% supplies by 20% by
by September
December 2013
2013
Delivery
Idea sheets
Safety
Morale
Measurement
Measurement
Measurement
Example: Reduce
the wait list by
20% by February
2014
Example:
Example: Improve
Reduce surgical
attendance by 10%
site infections to 0 by July 2013
% by January
2014
Process example
Referral
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Assessment
Treatment
17
Discharge
Measuring World-Class Quality
Quality
Reliability
Responsiveness
Consistent
Empathy
Equitable
Cost
World-Class
Quality
Price Effective
Right Place
Delivery
Right Time
Right Amount
For Patient
Safety
Morale
For Provider
Everyone Cares
Assurance of Quality
Cost Effective
Full
Customer*
Satisfaction
* Patient
Production Boards
• Manage by knowing how your
business is progressing
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@ 1996 – 2011 John Black and Associates,
Permission not granted to copy
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20
Clinic Visual
Daily Management Board
Used with permission from Park Nicollet Health Services
15 minute daily huddles
•
•
•
•
Select time of day
Start on time and designate a time keeper
All staff stand up in front of the visibility wall
Manager leads or designated leader
15 minute daily huddles
• Ask 4 questions:
– have any patients/residents fallen,
– were any employees injured,
– is there anyone off sick today,
– is there anyone here on overtime today (1 minute)
• Review communications/events (2 minutes)
• Update on projects (2 minutes)
• Review improvement ideas (2 minutes)
• Report out on your QCDSM measures- are they green or red
(meeting or not meeting your targets) ( 1 minute each)
• Update and review actions (3 minutes)
Keep in Mind…..
• The Visibility Wall is not in itself the goal – the discussions,
actions and accountability are what is important
• PDSA (Plan, Do, Study, Act) – keep pressure on your team
to get out and try implementing improvement ideas.
• The more people informed and trained in changes made,
the better chance that changes will be sustained
• If the team is stuck, go back to the purpose statement and
process steps for direction
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