1. Daily Management Visibility Wall Training February 2013
Kaizen Promotion Office

2. 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)

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

5. 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

6. “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

7. 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)

8. 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
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Front Line Mgrs 8

9. 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

10. 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

11. 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

12. 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

13. 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)

14. 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.

15. 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

16. 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

17. Process example Referral Assessment Treatment Discharge
Use as backup to show examples
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18. 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

19. 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

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

21. Daily Management Board
Clinic Visual
Daily Management Board
Used with permission from Park Nicollet Health Services

22. 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

23. 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)

24. 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