Daily ManagementVisibility Wall Training

February 2013

Kaizen Promotion Office

Daily Management

Strategy Deployment/ Hoshin

Kanri

DailyManagement

(DM)

Cross-FunctionalManagement

(CFM)

The system used by the organization to

perform its daily activities by:

• establishing standard operations

• identifying and eliminating waste

• using data to ensure processes, products

and services are continuously improved

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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 PeopleStaff 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

Visibility Levels

Hoshin 1 Hoshin 2 Hoshin 3

HOSHINKANRI

QCDSM

Focus on a few strategic priorities; align efforts to achieve breakthrough

improvementStrategic Visual Management

(Quarterly; Provincial Leaders )

Wall Walks(Weekly - CEO

& SLT)

Daily Visual Management(Daily or Weekly; Manager and point of care staff)

Alignment

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BETTER CARE

0 Nosocomial Infections

CEO Service Line Leader

Front Line Mgrs

why why

whywhy

whyWhy

PriorityReduce infectionsChart updated as of ______ (recent!)Action to be taken to return to

LTC Site 1 LTC Site 2

LTC Site 3 LTC Site 4

Strategic Visibility (Hoshins)3-5 Year Outcome Targets

Wall Walk - QCDSM

Daily Visual Management

Target Progress

VRE, MRSA, c.diff, ESBLHand Hygiene compliance

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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

• 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

Elements of the Daily Management System

• 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

Standardized Daily Management (DM)Visibility Wall

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…..

Core Processes

Team communication

Improvement

Quality

Example: improve wait time by 50% by September 2013

Cost

Example: Reduce OR supplies by 20% by December 2013

Delivery

Example: Reduce the wait list by 20% by February 2014

Safety

Example: Reduce surgical site infections to 0 % by 2014

Morale

Example: Improve attendance by 10% by July 2013

Team CalendarUpcoming This Week

Improvement ideas

•~~~~~~~~•~~~~~~~~•~~~~~~~~•~~~~~~~~•~~~~~~~~

Standard Work

•~~~~~~~~•~~~~~~~~

5S•~~~~~~~~•~~~~~~~~•~~~~~~~~•~~~~~~~~

Name Date Name Date Name Date Name Date Name Date

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?

Communications/Events Post what’s going on in theUnit/department. Ensure the information is Current and timely. Landing spot for staff to postInformation.

Improvement Ideas / Projects Area to post project forms – Rapid Process Improvement Workshop (RPIW), Value Stream Maps (VSM), Sort, Simplify, Sweep, Standardize and Self-discipline (5S projects).

Idea sheets

Quality

Measurement

Example: improve wait time by 50% by September 2013

Cost

Measurement

Example: Reduce OR supplies by 20% by December 2013

Delivery

Measurement

Example: Reduce the wait list by 20% by February 2014

Safety

Measurement

Example: Reduce surgical site infections to 0 % by January 2014

Morale

Measurement

Example: Improve attendance by 10% by July 2013

Process example

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Measuring World-Class Quality

World-Class Quality

Quality

Cost

Delivery

Safety

Morale

Full Customer* Satisfaction

Ass

uran

ce o

f Q

ualit

y

Everyone Cares

For Provider

For Patient

Right Amount

Right Time

Right Place

Price Effective

Cost Effective

Reliability ResponsivenessConsistentEmpathyEquitable

* Patient

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Production Boards

• Manage by knowing how your business is progressing

@ 1996 – 2011 John Black and Associates, Permission not granted to copy

Sample Home Care Viz Wall

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Sample LTC Viz Wall 2 0f 2 photos

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…..

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• 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