5. 03/12/15
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
6. 03/12/15 6
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
7. Visibility Levels
Hoshin 1 Hoshin 2 Hoshin 3
HOSHIN
KANRI
Q
C
D
S
M
Focus on a few strategic priorities;
align efforts to achieve breakthrough
improvement
Strategic Visual Management
(Quarterly; Provincial Leaders )
Wall Walks
(Weekly - CEO
& SLT)
Daily Visual Management
(Daily or Weekly; Manager and point of care staff)
8. Alignment
03/12/15
8
BETTER CARE
0 Nosocomial
Infections
CEO Service Line Leader
Front Line Mgrs
why why
whywhy
whyWhy
Priority
Reduce infections
Chart 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, ESBL
Hand Hygiene
compliance
9. 03/12/15
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
10. • 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
11. • 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
12. 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)
13. 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.
14. 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
15. 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
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
18. 03/12/15
Production Boards
• Manage by knowing how your
business is progressing
@ 1996 – 2011 John Black and Associates,
Permission not granted to copy
21. 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
22. 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)
23. Keep in Mind…..
03/12/15 24
• 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
Editor's Notes
Use for section Why DM? at 8.45
Use as backup to show examples
Have 2-3 examples of different vis walls on flip chart paper on the walls of the room so people can see vis wals
