visual management - leadership support for the front line

Daily Visual Management System Leadership Support for the Front Line

Lenore Howey – Laboratory Manager

www.qualitysummit.ca

#QS14

BETTER TEAMS

SHR Laboratory Lean Journey Continues …

Implementing Daily Visual Management into Standard Work

2006 ... 2010 … 2014…

Define Value

Value Stream

Create Flow Establish Pull

Pursue Perfection

Lean Principles

Define Value Performance

Value Stream process understanding

Create Flow eliminate

bottlenecks

Establish Pull continual beat

Takt time

Pursue Perfection continual

improvement

Lean Principles

Visual Management System Lean Communicational Tool

Visual Priorities – Goals

Visual Indicators of Performance

All are tied to a System at different levels

STEVEN R COVEY the community – empowering your greatness

https://www.stephencovey.com/community/resources/companion_films.php?f=12&s=l

Visual Boards• The end result must work for the area (level)• Different is OK• It is not about the board, it is about results• Objective of this presentation is to give you ideas to try

(PDSA) for your daily visual management system.

No involvement = No commitmentFront line produces the Bottom Line

Value StreamProcess + People + Measurements

Value = Customer (Patient)Goal = Performance Target

Leadership Development Understand your Value Stream of service

Base = system understanding

ProcessIntegrated steps/procedures in a system

• Each step/procedure is separate and unique• Each step/procedure is connected

The whole is only as good as the sum of the parts

c

People• Education – skills, ability and knowledge• Right person doing the right job

Tools • Standard Operating Procedures• Competence reviews• Performance Capacity and Variation• Schedule assignments to workload

Measurement/Data/Performance

Data required for objectivity of understanding

Some is not a numberSoon is not a time

SPH HV LabPhysician

Order

Specimen Management

HematologyChemistry

Results

Patient

Acute Care Wards

Patient Collection

Centres

Physician

• High Volume Laboratory• Delivery of Test Results• 5 areas of work• Each area has internal processes• Each area is connected • Customer only feels the system results

PEOPLE

Who does What? When? How?= Standard Work

People = Scheduled to Workload - Level the Load

Data Entry Report Dist.

HematologyChemistry

Patient Collections

Acute Care Wards

10 Storm (7-9am) 4 Days 3 Evenings 1 Nights

3 (8-12)2 (12-230)

5 Days 3 Evenings 1 Nights

7 Days 3 Evenings 1 Nights

Patient Collections

SPH Test Centre

5 Days 3 Evenings

Specimen Management

2 x 12hr1 x 8hr (T,W,Th)

Measurement – TAT

April

May Aug Nov Dec Fe

bM

arJu

ne July

Aept

Oct

2014

70%

80%

90%

100%

SPH Emergency Phlebotomy- Collected to Rec'd in Lab Target: Stats<15mins Urgents<30mins

TA

T P

erc

en

t

Focused initiative to ensure timely

return of Emergency

samples

Thumb on the Pulse – Daily Measure

Timely review of outliers

• Equipment• Training • 5S + Safety• Celebrations• Process Improvement Monitoring• Rock in your Shoe – front line identified concerns/constraints

Additional Components of Visual Management System

Step out of Comfort - PDSA• How can we learn if we don’t try• Failures teach us• Not always about the success• Predict and test the theory• Reflection and refocus

• Cycles repeat

Base = System Thinking Learning

Know

Quality is a Systematic ProcessSystem of Profound Knowledge

Theory of Knowledge

Psychology of Change

Understand Variation

Application of a System

System Thinking

Know

Let’s put it all together

forVisual Management

1st PDSA of Daily Management – Fall 2012

3rd PDSA – Jan 2013

5th PDSA – June 2013

Daily Management April 2014

Process + People

System Monitoring

Daily Management System

Connection of all parts = System

Standard work to ensure Front Line is supported

“The Front Line produces the Bottom Line”

Daily Huddle Communication CascadeTime Mon Tues Wed Thurs Fri

0800 Daily Leadership – daily review system - people/process/measurement

0830 Daily Managers/Director – daily conference call SPH Site SHR *SLT Lab *LOC

1000 General staff Huddle – SPH Laboratory

1300 Hematology

1500 Chemistry Front Line daily huddles – area specific

1500 Spec. Mgmt

0800hrs = Front Line Leadership Huddle

30 min max

0830hrs = Manager/Director Conference CallDaily LMM Report Out

Lori Goldie Lenore Diane Betty Lorrie

RRS Histology Cytology Clerical Autopsy LIS SP Man DE Chemistry Hematology Chemistry Phlebotomy Bacteriology Virology Molecular TBProcess Workers, MOA Immuno TML HLA Cytogenetics RUH Hem HMG

Saturday

OT (hrs)

Sick Time/Family Leave (# of staff)

Shifts above Base

Shifts NOT replaced

Operational Issues

Staff Injuries-type

Sunday

OT (hrs)

Sick Time/Family Leave (# of staff)

Shifts above Base

Shifts NOT replaced

Operational Issues

Staff Injuries-type

Monday

OT (hrs)

Sick Time/Family Leave (# of staff)

Shifts above Base

Shifts NOT replaced Operational Issues

Staff Injuries-type

Tuesday

OT (hrs)

Sick Time/Family Leave (# of staff)

Shifts above Base

Shifts NOT replaced

Operational Issues

Staff Injuries-type

Wednesday

OT (hrs)

Sick Time/Family Leave (# of staff)

Shifts above Base

Shifts NOT replaced

Operational Issues

Staff Injuries-type

Thursday

OT (hrs)

Sick Time/Family Leave (# of staff)

Shifts above Base

Shifts NOT replaced

Operational Issues

Staff Injuries-type

Friday

OT (hrs)

Sick Time/Family Leave (# of staff)

Shifts above Base

Shifts NOT replaced

Operational Issues

Staff Injuries-type

30min max total

Standard Template for ReportLenore

SP Man DE Chemistry HematologyOT (hrs) Sick Time/Family Leave (# of staff)

Shifts above Base

Shifts NOT replaced

Operational Issues

Staff Injuries-type

All Laboratory staff SHR System connection communication SHR –Leaders Connected Sharing SPH – 0830 Monday site huddle Regional Laboratory – previous week LOC SPH Laboratory – staffing, lab specifics Celebrations – from staff, site, region

Notes sent via internal mail message

1000hrs = General Huddle - Monday30min max

Chemistry

1500hrs –Front Line Huddle

15min Target30min Max

Hematology1300hrs –Front Line Huddle

15min Target30min Max

Spec. Management15min Target30min Max

1500hrs – Front Line Huddle

Week 1 = Quality and SafetyWeek 2 = DeliverablesWeek 3 = CostWeek 4 = Strategic Projects

Clinical Department HeadDirectorManagersClinical Dyad Leaders

0830hrs *LOC = ThursdayLab Operations Committee

1 hour Max – 3 min takt \ report 5 Divisions 3 Urban + Rural

SHR Leadership Visibility BoardSenior Leadership (SLT) HuddleSaskatoon City HospitalOrganizational review of Goals/Progress

Week 1 – Quality and SafetyWeek 2 - DeliverableWeek 3 - CostWeek 4 – Strategic Plans/Reports

Tuesday

Huddles = Regroup/Refocus

Visual Boards Eye on the GOALCommunication

Each level connected Cascades

Feedback

Dr. Andrew Lyon (Clinical Biochemist - SPH Lab)- it is in a high traffic area and everyone coming in and out of the

department can check it at a glance.- ‘easy?'........some days when problems are repetitive, it is a bit harder- It makes me feel more 'connected' to the lab staff- Don't forget to put up celebrations & fun things

Feedback

RUH Phleb – Staff feel the board is theirs – they write down items they feel should be “huddled”

Manager – Thankful our huddle system was in place when Level 4 organism was suspected. Daily communication system was already standardized

Director – • feels better connected to what is going on even when I’m not at the

huddles• “Rich” conversations are vital to understand• Not about the look of the board, it’s the conversations, interaction• See progress “at a glance” when on Gemba walks

l

Pursuing Perfection

PredictableReliable

Defect freeNo Harm

We are all on the same roadImagine what we can do

Make it VISUAL - Communicate

Through focus we will reach our Goals Together

Visual Management System

Questions?

Contact Me:Lenore Howey

Laboratory Manager, SHRlenore.howey@saskatoonhealthregion.ca

www.qualitysummit.ca

#QS14