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 identifying and eliminating waste using data to ensure processes, products and services are continuously improved Strategy Deployment/ Hoshin Kanri Daily Management (DM) Cross-Functional Management (CFM)

Daily Management Link to Hoshin Use for section Why DM? at 8.45 4/22/2017

Daily 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 4/22/2017

“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 4/22/2017

Strategic Visual Management Visibility Levels Focus on a few strategic priorities; align efforts to achieve breakthrough improvement HOSHIN KANRI Strategic Visual Management (Quarterly; Provincial Leaders ) Hoshin 1 Hoshin 2 Hoshin 3 Q C D S M Wall Walks (Weekly - CEO & SLT) Daily Visual Management (Daily or Weekly; Manager and point of care staff)

0 Nosocomial Infections Alignment Strategic Visibility (Hoshins) BETTER CARE 3-5 Year Outcome Targets 0 Nosocomial Infections Why why Target Progress Wall Walk - QCDSM why why Priority Reduce infections Chart updated as of ______ (recent!) Action to be taken to return to VRE, MRSA, c.diff, ESBL Hand Hygiene compliance Service Line Leader CEO why why Daily Visual Management LTC Site 1 LTC Site 2 LTC Site 4 LTC Site 3 4/22/2017 Front Line Mgrs 8

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 4/22/2017

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

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 4/22/2017

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.

Quality Cost Delivery Safety Morale 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 Upcoming This Week Team Calendar 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 the Unit/department. Ensure the information is Current and timely. Landing spot for staff to post Information. 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 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 January 2014 Morale Example: Improve attendance by 10% by July 2013

Process example Referral Assessment Treatment Discharge Use as backup to show examples 4/22/2017 17

Measuring World-Class Quality Reliability Responsiveness Consistent Empathy Equitable Quality Cost Effective Cost Price Effective World-Class Quality Full Customer* Satisfaction Assurance of Quality Right Place Delivery Right Time Don’t show - just for backup if needed * Patient Right Amount For Patient Safety For Provider Morale Everyone Cares

Sample Home Care Viz Wall Production Boards Manage by knowing how your business is progressing Have 2-3 examples of different vis walls on flip chart paper on the walls of the room so people can see vis wals 4/22/2017

Sample LTC Viz Wall 2 0f 2 photos 4/22/2017

Daily Management Board 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 4/22/2017