Daily Visual Management Visibility Wall Training June 18, 2014 Kaizen Promotion Office

Presentation/training (35 minutes) Video (10 minutes) Session Agenda: Session Agenda Presentation/training (35 minutes) Video (10 minutes) Group work creating your draft walls (45 - 50 minutes) Group report-outs (15 – 20 minutes) Q&A (5 minutes) Wrap-up and evaluation forms

Government of Saskatchewan Strategic Hierarchy Government of Saskatchewan Ministry of Health Provincial Health System Regina Qu’Appelle Health Region

Reporting and Accountabilities

Strategic Framework

RQHR Strategic Planning and Reporting Cycle

Daily Visual Management 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 Strategy Deployment/ Hoshin Kanri Daily Visual Management (DVM) Cross-Functional Management (CFM)

Daily Visual Management- Link to Strategy

Daily Visual Management Consists of: A Visual Workplace where abnormalities are seen An environment where staff test their own ideas Transparency of objectives and metrics Managing by measures that change regularly Connects accountability throughout the organization What you cannot see, you cannot manage! - Visual Management

“Before cars, make people.” —Eiji Toyoda, former chairman of Toyota 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

Zero Waits in Emergency Alignment Better Care 1-5 Year Outcome Targets Zero Waits in Emergency why why Corporate Wall VP/ ED/ Director Wall why why VP / ED / Dir. Pasqua ED why why Unit / Department Wall RGH ED Front Line Managers

You Don’t Need to know Lean to get started on Daily Visual Management! It is critical to understand the current situation first, before applying Lean techniques and tools to make improvements 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

Elements of the Daily Visual 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 Only measure something you can action

What Should I Do? 1. Go and see – learn from the workplace 2. Make the workplace visual 3. Spend significant time developing people 4. Teach staff to see, create solutions and improve 5. Provide standard work that staff can use as a basis for improvement, and develop your own standard work 6. Never stop improving 7. Be accountable and hold others accountable

Setting Up a Daily Visual Management Visibility Wall: Step-By-Step

Purpose statement: Core Processes Team communication Improvement Who are we from the patient perspective? 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 Upcoming This Week Team Calendar Improvement ideas ~~~~~~~~ Standard Work ~~~~~~~~ 5S Corporate Memo’s Training Staff Bouquets Admit Treat Discharge Name Date Name Date Name Date Name Date Name Date

Steps to Creating a Daily Visual Management Visibility Wall 1. Articulate the Purpose Statement of the service area i.e. Our purpose is to support teams through Lean methodology to create a world-class Saskatchewan Healthcare System, which provides high quality, safe and timely care. Don’t forget the patient perspective in your Purpose Statement 2. Identify the primary process in your service area and draw a value stream or process map 3. 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? Training schedule? Staff bouquets? Corporate communication's/memo’s?

Steps to Creating a Daily Visual Management Visibility Wall 4. 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. 5. What are one or two measures that best describe how you are meeting the core purpose? Classify your measures under: Quality, Cost, Delivery, Safety, Morale (QCDSM) Only measure what you can directly improve Coming soon: there will be some corporate standard measures

Measuring World-Class Quality Reliability Responsiveness Consistent Empathy Equitable Quality Cost Effective Cost World-Class Quality Full Customer* Satisfaction Assurance of Quality Right Place Delivery Right Time Right Amount * Patient For Patient Safety For Provider Morale Everyone Cares

Purpose statement: Core Processes Team communication Improvement Who are we from the patient perspective? 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 Upcoming This Week Team Calendar Improvement ideas ~~~~~~~~ Standard Work ~~~~~~~~ 5S Corporate Memo’s Training Staff Bouquets Admit Treat Discharge Name Date Name Date Name Date Name Date Name Date

Photos: Pasqua Cardio Neuro

Photos: WRC Children’s Program

Photos: WRC Extended Care/Veterans Program

Photos: Pasqua Radiology

Photos: RGH Surgical 6A

Select a consistent time of day for wall walks Start on time 15 Minute Daily Huddle Select a consistent time of day for wall walks Start on time Designate a time keeper so that you can end on time All staff stand up in front of the visibility wall Manager leads or designated leader Consider having other staff be reasonable for some pieces of the data and have them report-out out on the data

15 Minute Daily Huddle: Agenda 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

If you have any questions or want more information, contact: Sandra Lynn at sandra.lynn@rqhealth.ca or 306-766-6421 More information can also be found on the Intranet at: http://rhdintranet/qi/public/VisibilityWallsKit/VisibilityWallsKit.htm (Departments > Kaizen Promotion Office > Visibility Wall Kits) Or at www.RQHRLean.com