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 Business intelligence –Business Review Deck –Quality Dashboard Readmissions Core Measures HCAHPS Knowledge portal Daily Review Continuous improvement activities Huddles

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?

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

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.

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